《12.08.06Anal fistula plug for closure of difficult anorectal fistula》.pdf

Anal Fistula Plug for Closure of Difficult Anorectal Fistula: A Prospective Study 1 2 2 Paul J. van Koperen, M.D., Andre D_Hoore, M.D., Ph.D., Albert M. Wolthuis, M.D., 1 1 Willem A. Bemelman, M.D., Ph.D., J. Frederik M. Slors, M.D., Ph.D. 1 Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands 2 Department of Abdominal Surgery, Gasthuisberg, University Clinics, Leuven, Belgium PURPOSE: Complex high and recurrent fistulas remain a opening while preserving continence. Submucosal, surgical challenge. Simple division, i.e., fistulotomy, will intersphincteric, and low transsphincteric fistulas in likely result in fecal incontinence. Various surgical treat- the lower one-third of the external sphincter com- ment options for these fistulas have shown disappointing results. Recently a biologic anal fistula plug was developed plex are easy to treat by simple fistulotomy, with a to treat these high transsphincteric fistulas. To assess the favorable success rate and relatively little impact on results of the anal fistula plug in patients with complex fecal continence. high perianal fistulas, a prospective, two-center, clinical study was undertaken. METHODS: Between April 2006 and High transsphincteric fistulas remain a surgical October 2006, a consecutive series of patients with difficult challenge. Simple division, i.e., fistulotomy, will therapy-resistant high fistulas were enrolled. During sur- likely result in fecal incontinence.1–3 In recent years, gery, the internal fistula t