Schwandner O
Department of Surgery and Pelvic Floor Center, Caritas-Krankenhaus St. Josef, Regensburg, Germany.
Minerva Chir. 2008 Oct;63(5):413-9.
Impressed by the initial success rates of 80% of the anal fistula plug for the closure of cryptoglandular and Crohn's associated anorectal fistulas, preliminary results from centers world-wide showed a healing rates between 24% and 88%. When compared to traditional flap repair for closing high anorectal fistulas, impairement of continence may be decreased using the plug procedure. Analyzing the different experiences of the plug procedure ranging from promising to disappointing results, a variety of issues such as bowel preparation, treatment of fistula tract, closure of the internal opening, and postoperative management have to be considered. Furthermore, the ''ideal'' indication has still to be defined. At the moment, all results which have been published only provide short-term results, and the question whether the plug procedure is appropriate and effective in Crohn's disease cannot be answered definitely. Finally, the question how to proceed in patients with plug dislodgement or failure remains unclear. In general, the introduction of the plug has accelerated a ''new'' discussion on the optimal treatment of complex fistulas. Further analysis is needed to explain the definite role of this innovative technique in comparison to traditional surgical techniques.
肛瘘栓对隐窝腺性和克罗恩病相关的肛肠瘘的闭合成功率最初达到80%，给人留下深刻印象，全球各中心的初步结果显示愈合率在24%至88%之间。与传统皮瓣修复术治疗高位肛肠瘘相比，使用栓治疗法可能会减少控便功能的损害。分析栓治疗法从有希望到令人失望的不同经验，必须考虑各种问题，如肠道准备、瘘管处理、内口闭合及术后管理。此外，“理想”的适应证仍有待确定。目前，所有已发表的结果仅提供短期结果，栓治疗法在克罗恩病中是否合适和有效这一问题尚无法明确回答。最后，对于栓移位或失败的患者如何处理仍不清楚。总体而言，栓治疗法的引入加速了关于复杂肛瘘最佳治疗方法的“新”讨论。需要进一步分析以解释这一创新技术与传统手术技术相比的确切作用。
