Our Summary

This paper is a review of several studies that looked at how effective anal fistula plugs (AFPs) are in treating a condition called fistula-in-ano in patients with Crohn’s disease. Fistula-in-ano is a channel that develops between the end of the bowel and the skin near the anus.

The researchers looked at 16 studies published between 1995 and 2015, and included 12 of those in their review. They were particularly interested in the success rate of the treatment, which they defined as the fistula channel closing up. They found that in total, the success rate was just over 58%, but this varied depending on factors like the brand of plug used and whether the patient had previously had a recurrent anal fistula.

They also looked at how often the fistula came back after treatment. They found that in the studies that reported this information, the recurrence rate was about 14%.

Interestingly, the review found that patients who were given certain drugs before their operation had lower success rates than those who did not receive these drugs.

In conclusion, the researchers suggest that using an AFP to treat fistula-in-ano in patients with Crohn’s disease is generally safe and reasonably successful, with little associated risk. However, they also point out that the studies they reviewed had some limitations, such as small numbers of participants, variations in surgical technique, and differences in how the condition was managed before surgery.

FAQs

  1. What is the overall success rate of using anal fistula plugs (AFPs) in treating fistula-in-ano in patients with Crohn’s disease according to the studies?
  2. How often does the fistula recur after treatment with anal fistula plugs, based on the studies reviewed?
  3. Did the use of certain drugs prior to the operation impact the success rate of fistula-in-ano treatment?

Doctor’s Tip

One helpful tip a doctor might give a patient about anal fistula surgery is to carefully follow post-operative care instructions to promote proper healing and reduce the risk of complications. This may include keeping the area clean, avoiding strenuous activities, and taking prescribed medications as directed. Additionally, it’s important to attend follow-up appointments with your healthcare provider to monitor your progress and address any concerns that may arise.

Suitable For

Overall, patients with Crohn’s disease who have fistula-in-ano and have not had success with other treatments may be recommended anal fistula surgery with an anal fistula plug. These patients may have a higher chance of success if they have not had a recurrent anal fistula and do not receive certain drugs before the operation. However, it is important for patients to discuss their individual circumstances with their healthcare provider to determine the best course of treatment for their specific situation.

Timeline

Before anal fistula surgery:

  • Patient may experience symptoms such as pain, swelling, discharge, and recurrent abscesses near the anus
  • Patient may undergo tests and examinations to diagnose the fistula and determine the best treatment approach
  • Patient may be prescribed medications to manage symptoms and reduce infection

After anal fistula surgery:

  • Patient may experience pain, discomfort, and swelling in the area of the surgery
  • Patient may need to take pain medications and antibiotics to prevent infection
  • Patient may need to change dressings and follow-up with their healthcare provider for regular check-ups
  • Patient may need to make lifestyle changes, such as maintaining good hygiene and avoiding certain activities to promote healing
  • Patient may undergo follow-up tests and examinations to monitor the success of the surgery and address any complications that may arise

What to Ask Your Doctor

  1. What is an anal fistula and why do I need surgery to treat it?
  2. What are the potential risks and complications associated with anal fistula surgery?
  3. How successful is anal fistula plug surgery in treating fistula-in-ano in patients with Crohn’s disease?
  4. What is the recurrence rate of anal fistulas after surgery with anal fistula plugs?
  5. Are there any specific factors, such as previous recurrent anal fistulas, that may affect the success of the surgery?
  6. Are there any alternative treatment options for anal fistulas in patients with Crohn’s disease?
  7. What medications should I avoid before surgery to optimize the success rate of the anal fistula plug?
  8. How long is the recovery time after anal fistula surgery with a plug?
  9. Will I need follow-up appointments after the surgery, and how often?
  10. Are there any lifestyle changes or precautions I should take after the surgery to prevent recurrence of anal fistulas?

Reference

Authors: Nasseri Y, Cassella L, Berns M, Zaghiyan K, Cohen J. Journal: Colorectal Dis. 2016 Apr;18(4):351-6. doi: 10.1111/codi.13268. PMID: 26749385