Anal Fistula Plug: A European Perspective

Impressed by the initial success rates (80%) of the Cook Surgisis AFP anal fistula plug for the closure of both cryptoglandular and Crohn's associated anorectal fistulas, the preliminary results from Europe showed healing rates of 41% and 61%, respectively. However, no impairment of continence was documented. Analyzing the current experiences of the plug procedure from a German perspective, a variety of issues are under debate including the role of bowel preparation, treatment of fistula tract, closure of the internal opening, postoperative management, and, finally, financial reimbursement. Furthermore, the “ideal” indication has to be defined. In general, the introduction of the plug has accelerated a “new” discussion on the optimal treatment of high anorectal fistulas. Further analysis is needed to explain the definite role of this innovative technique in comparison to traditional surgical techniques, particularly whether the plug can offer the biological properties required for permanent fistula healing. Consequently—as a European perspective—the randomized German multicenter study comparing the plug procedure vs. advancement flap repair for transsphincteric fistulas will hopefully elucidate the definite role of the plug.