What is the typical healing rate after placing a bioprosthetic fistula plug for low transsphincteric anal fistulas in adults

What is known

- A collagen plug cohort showed closure declining over time from 84% early to ~55% at median 6.5 months, with simple fistulas closing far better than complex (70.8% vs 35%). ¹ - A porcine SIS plug series of predominantly transsphincteric fistulas reported a 38% closure rate. ² - A review cites fistula healing between 38% and 71% but with high recurrence of 50–70%, and ~55% pooled closure in Crohn's patients. ³

What is unknown / caveats

- A multicenter fistulotomy study found the plug had the lowest success rate of compared options - Comparative cohorts report plug closure significantly lower than advancement flaps - Excerpts report transsphincteric fistulas broadly, not low transsphincteric specifically - Wide heterogeneity in patient selection, technique, and follow-up length - Recurrence rates high (50–70%), so early healing overstates durable success - No retrieved study reports a healing rate stratified specifically to low transsphincteric fistulas in adults.

## References

1. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum. 2008;51(6):838-43. PMID: 18330649.

2. Cintron JR, Abcarian H, Chaudhry V, Singer M, Hunt S, Birnbaum E, Mutch MG, Fleshman J. Treatment of fistula-in-ano using a porcine small intestinal submucosa anal fistula plug. Tech Coloproctol. 2013;17(2):187-91. PMID: 23053440.

3. Sheedy Shannon P, Bruining David H, Dozois Eric J, Faubion William A, Fletcher Joel G. MR Imaging of Perianal Crohn Disease. Radiology. 2017;282(3):628-645. PMID: 28218881.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._