Anal Fistula...
Q. What is Anal Fistula Plug & how is
this procedure done ?
Anal Fistula Plug is made up of sub
mucosa of small intestine and is a highly sophisticated absorbable material which
is absorbed/dissolved by the body in 6-8 weeks. This plug is placed and
anchored in the fistula tract by a special technique and the internal opening is
closed over it. It provides the scaffold over which body’s collagen gets
deposited and closes the fistula. The Anal Fistula Plug(AFP) has been approved
for clinical use by US FDA [United States Food & Drug Administration]in
May, 2005.-
Q What are the advantages & disadvantages of Anal Fistula Plug
procedure?
ADVANTAGES
·
Non-invasive- The procedure involves no cutting,
scarring or distortion of anatomy at all.
·
Little pain- The procedure is associated with
comparatively little pain as
there in no cutting involved.
·
Early recovery- Recovery is very fast and the patient
can be back to work with in a short span.
·
Less morbidity- There is no new wound formation and no
extensive post operative dressings are required.
·
Short Hospitalization- The patient can usually be discharged in 12-24
hours after the procedure.
·
Can be used again after a failure- In case of a failure, the procedure
can be repeated without any risk or drawback.
·
NO RISK of Incontinence- There is absolutely no risk of
incontinence even in high fistulas and complex fistulas. Somebody has remarked ”For high Fistula, AFP method is a
boon sent directly from heaven”.
·
‘Biological’ closure- This procedure is a biological closure
of the fistula tract rather than a ‘Mechanical’ closure’ as in advancement
flap.
·
Minimal foreign body reaction- Studies have shown that there is
minimal foreign body reaction to the
plug material.
·
Resistant to infection- The plug is made up of special
material which is resistant to infection. This factor helps as the plug has to
be placed in an infected environment.
·
High Success rate - Studies have shown the success rate of
Anal Fistula Plug treatment to be in the range of 70-87%.
·
PROCEDURE OF CHOICE- The Anal Fistula Plug is the
treatment of choice in
1
High Fistula
2.Long, complex fistulas
3. Recurrent fistulas
4. Horse-shoe fistulas,
5. Anterior radial fistulas
6. Crohn’s disease.
7. Rectovaginal fistulas( Long term
results awaited)
8. Low fistula when patient doesn’t
want pain, long hospitalization, delayed recovery and scarring.
DISADVANTAGES/Complications
|
1.
Higher Cost-
The cost of the plug is on slightly higher side which becomes a deterrent for a few.
2.
Chances of
Failure - Though Anal Fistula Plug
has high success rate, still it is not
successful in some patients. But even in these patient (with recurrence) ,
this procedure can be repeated without any harm/risk.
3. Plug
Extrusion- The plug can be extruded in 10-20% of cases.
4. Abscess
formation- There can be abscess formation in 4-8%.
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A Anal Fistula Plug in the fistula
tract before anchoring |
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