The anal fistula plug in Crohn's disease patients with fistula-in-ano: a systematic review

Aim This study aimed to review, consolidate and analyse the findings of studies investigating the efficacy of anal fistula plugs (AFPs) in treating fistula‐in‐ano in patients with Crohn's disease. Method A literature review was conducted via Pubmed, Embase, Medline, Scopus and the Cochrane Libr...

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Bibliographic Details
Published in:Colorectal disease 2016-04, Vol.18 (4), p.351-356
Main Authors: Nasseri, Y., Cassella, L., Berns, M., Zaghiyan, K., Cohen, J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Anal fistula plug
Crohn Disease - complications
Crohn's disease
Digestive System Surgical Procedures - instrumentation
Digestive System Surgical Procedures - methods
Female
fistula-in-ano
Humans
Male
Middle Aged
Rectal Fistula - etiology
Rectal Fistula - surgery
Surgical Instruments
systematic review
Treatment Outcome
Young Adult
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Summary:Aim This study aimed to review, consolidate and analyse the findings of studies investigating the efficacy of anal fistula plugs (AFPs) in treating fistula‐in‐ano in patients with Crohn's disease. Method A literature review was conducted via Pubmed, Embase, Medline, Scopus and the Cochrane Library for the period 1995–2015. Articles were selected and reviewed based on specific inclusion and exclusion criteria. Results A total of 16 studies were extracted, of which 12 were included in the systematic review. In total, 84 patients (n = 1–20 per study) with a median age of 45 (18–72) years and a median follow‐up time of 9 (3–24) months were analysed. The total success rate, defined as closure of the fistula tract, was 49/84 (58.3%, 95% CI 47–69). Success in patients with recurrent anal fistulae was 2/5 (40%, 95% CI 5–85). Overall, the success rates of Surgisis® and GORE® BIO‐A® brand plugs were 48/80 (60%, 95% CI 48–71) and 1/4 (25%, 95% CI 1–81). The recurrence rate of fistula‐in‐ano in the five studies that reported recurrence was 3/22 (13.6%). In two comparative studies, inferior overall success rates were found in patients who received preoperative immunomodulators vs those who did not [3/11 (27.3%) vs 17/23 (73.9%)]. Conclusion The studies suggest that the use of an AFP in patients with Crohn's disease is a safe procedure with reasonable success, little morbidity and a low risk of incontinence. The current literature is limited by a number of factors, including small study cohorts, grouping of fistulae in Crohn's disease with other types of anal fistula, short and highly variable follow‐up times and multiple confounding factors such as number of fistula tracts, use of preoperative steroids or immunosuppressants, previous use of setons and variation in surgical technique.
ISSN:1462-8910
1463-1318
DOI:10.1111/codi.13268