Healing rate after fistula plug for transsphincteric fistula

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.