Biologic fistula plugs

Numerous biologic agents have been employed over the last 2 decades to aid in the closure of anal fistulae. The general principles in their use remain constant: closure of the internal opening and separation of the fistulous tract. Biologic glues have been used to promote fistula closure, however, over time they have not proven effective. More recently, a variety of allograft, xenograft, and other manufactured acellular matrices have also been employed as plugs to aid in anal fistula closure. This field is still in its infancy and preliminary data has been mixed. Fistula plugs have a place in recurrent and difficult-to-treat fistulae; however more data is needed to determine their true effectiveness.