Synthetic fistula plug

The importance of understanding and treating anorectal fistulae is evidenced not only by the prevalence of this condition but also by the variety of approaches involved. There is currently neither a consensus nor a set of guidelines on the management of anorectal fistulae. Whether the fistula is simple or complex, it is paramount to maintain fecal continence and decrease recurrence. Historical approaches have included fistulotomy with or without marsupialization, seton placement, and endorectal advancement flaps, each with variable success rates. More recently, synthetic and biologic plugs have become available as adjuncts in fistula management. In this chapter, we discuss the available plugs, their chemical composition, and contraindications to and recommended techniques of application, including optimal disk placement. We also review several studies with a focus on success and recurrence rates when using the Surgisis or Gore Bio-A plug. Overall the Gore Bio-A appears to be an improvement over the Surgisis plug. However, further studies are required to clearly define its indications and application.