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Treatment of Transsphincteric Anal Fistulas by Endorectal Advancement Flap or Collagen Fistula Plug: A Comparative Study

Christoforidis, Dimitrios M.D.1; Pieh, Matthew C. M.D.2; Madoff, Robert D. M.D.1; Mellgren, Anders F. M.D., Ph.D.1

Diseases of the Colon & Rectum: January 2009 - Volume 52 - Issue 1 - p 18-22
doi: 10.1007/DCR.0b013e31819756ac

PURPOSE: In this study we compared the outcomes of patients with complex cryptoglandular fistulas treated by endorectal advancement flap or anal fistula plug.

METHODS: We performed a retrospective analysis of patients with transsphincteric anal fistulas treated by endorectal advancement flap or anal fistula plug from January 1996 through April 2007. Patients with noncryptoglandular fistulas or insufficient follow-up were excluded. Results were obtained with a combination of chart reviews, mailed questionnaire, and phone interviews. Success was defined as a closed external opening in absence of symptoms at a minimal follow-up time of six months.

RESULTS: Forty-three patients had an endorectal advancement flap and 37 patients had an anal fistula plug procedure. The two cohorts were comparable for age, gender, smoking status, fistula type, and previous failed treatments. The success rate was 63 percent in the endorectal advancement flap group and 32 percent in the anal fistula plug group (P = 0.008), after a mean follow-up of 56 (range, 6-136) months for endorectal advancement flap and 14 (range, 6-22) months for anal fistula plug.

CONCLUSIONS: The current study indicates that the endorectal advancement flap provides a higher success rate than the anal fistula plug. Randomized trials are needed to further elucidate the efficacy and potential functional benefit of the anal fistula plug in the treatment of complex anal fistulas.

1 Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota

2 Carleton College, Northfield, Minnesota

Matthew Pieh received an educational grant from Cook Medical Inc, Bloomington, Indiana.

Dr. Anders Mellgren received an honorarium for research consulting (two meetings) from Cook Medical.

Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachussetts, June 7 to 11, 2008.

Reprints are not available

Dr. D. Christoforidis' research fellowship was supported by grants from the SICPA Foundation, Lausanne, Switzerland, the Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland and the Minnesota Colon and Rectal Foundation.

Address of correspondence: Anders F. Mellgren, M.D., Ph.D., Riverside Professional Building, 606 24th Avenue South, Suite 515, Minneapolis, Minnesota 55454. E-mail:

© The ASCRS 2009