Outcomes of anal fistula surgery in patients with inflammatory bowel disease

Am J Surg. 2010 May;199(5):609-13. doi: 10.1016/j.amjsurg.2010.01.007.


Background: Anal fistulas in patients with Crohn's disease are especially difficult to manage because of nonhealing and incontinence. We reviewed our outcomes for the newer sphincter-preserving techniques of anal fistula plug and fibrin glue compared with standard treatments of advancement flap closure and seton drain insertion.

Methods: This was a retrospective study of patients with inflammatory bowel disease treated for high transsphincteric anal fistulas. The primary outcome was healing and continence at 12 weeks postoperatively.

Results: Between 1997 and 2009, 51 patients with anal fistulas and inflammatory bowel disease were identified in the St Paul's Hospital Anal Fistula Database. Postoperative healing rates at 12 weeks for the fistula plug, fibrin glue, flap advancement, and seton drain groups were 75%, 0%, 20%, and 28%, respectively. Continence scores were not altered by these procedures.

Conclusions: Closure of the primary fistula opening in patients with inflammatory bowel disease using a biologic anal fistula plug had improved healing compared with fibrin glue, seton drain, and flap advancement. Given its low morbidity and relative simplicity, the anal fistula plug should be considered for treating high transsphincteric anal fistulas in patients with inflammatory bowel disease.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Digestive System Surgical Procedures / methods
  • Fecal Incontinence / prevention & control
  • Female
  • Fibrin Tissue Adhesive / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / diagnosis*
  • Inflammatory Bowel Diseases / surgery
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Postoperative Complications / physiopathology
  • Quality of Life
  • Rectal Fistula / complications
  • Rectal Fistula / diagnosis
  • Rectal Fistula / surgery*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Surgical Flaps*
  • Tampons, Surgical*
  • Treatment Outcome
  • Young Adult


  • Fibrin Tissue Adhesive