Anal Fistula Repair with Acellular Dermal Matrix Plug: Description of a Novel Technique and Early Results

Background: The interest of colorectal surgeons has shifted over the years towards the development of “sphincter-saving” surgical techniques. The aim of the present study was to evaluate the efficacy of the new device in terms of healing, biocompatibility and postoperative complications. Method: A total of 12 patients with high transphincteric anal fistulas were treated with a new acellular dermal matrix (ADM) plug. All patients were preoperatively examined by means of rectoscopy and transanal ultrasound and underwent placement of a silk or silicone seton for a minimum period of two months in order to consolidate and drain the fistular track. The plug was surgically positioned through a “press-fit” technique. Patient's demographics, fistulas' etiology and success rates were recorded. During the follow-up, healing time of the fistulae, continence and postoperative pain were evaluated. Results: From January 2012 to May 2013, 7 men and 5 women underwent a plug insertion in our institution. The average age was 52.3 years (range 31-70). The fistulas were either of cryptoglandular origin (5; 41.7%) or secondary to chronic fissure (7; 58.3%). Six patients (50%) had history of previous failed surgery, while the remaining 6 patients (50%) were surgically treated for the first time. 9 of the 12 patients (75%) achieved clinical healing with average follow-up of 9.33 months. Conclusion: The anal fistula ADM plug was associated with a good success rate and less postoperative morbidity, compared to similar series in the literature. The product demonstrated high biocompatibility. The new developed surgical technique allowed plug implantation maintaining both intimate contact with the fistular track and primary stability, which are known to be crucial requirements for the device's incorporation. Further studies will be needed to evaluate the impact of patient selection on overall therapeutic success.