{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:03:04Z","timestamp":1778169784929,"version":"3.51.4"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Tech Coloproctol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Backgound<\/jats:title><jats:p>Effective,\u00a0standardized treatments for complex anal fistula (CAF) still represent a clinical\u00a0challenge. Emerging procedures attempted\u00a0to achieve the healing\u00a0rates of fistulotomy whilst preserving sphincter function. Acellular dermal matrix (ADM) used as a plug inserted through the\u00a0fistulous tract is among newer treatment options. Varying success rates have been reported, most with short-term follow-up.\u00a0The aim of this study was to report the long-term results of ADM-plug for CAF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective\u00a0analysis of a prospective database of patients treated with CAF.\u00a0All consecutive patients presenting at two tertiary centers (Vall d\u2019Hebron University Hospital and Bellvitge University Hospital, Barcelona, Spain) between November 2015 and March 2019 with a single, cryptoglandular CAF were evaluated for treatment with an ADM-plug were included. The primary endpoint was absence of discharge at clinical examination at 12\u00a0month follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-two patients were included [7 women and 15 men, median age 56 (33\u201374) years]. Most patients had high\u00a0transsphincteric fistulas\u00a0(63.6%). The median follow-up was 42 (21\u201353) months. The 12\u00a0month success rate was 68.2%, with an overall healing rate of 59.1%. 77.8% of recurrences occurred within 12\u00a0months from surgery. One plug extrusion was observed. No major complications or mortality occurred during the follow-up.\u00a0Patients did not report any\u00a0worsening\u00a0of fecal continence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This pilot study showed that more than half of patients with CAF could benefit from ADM-plug placement, preserving continence. A minimum follow-up of 12\u00a0months is recommended, because most recurrences occur during the first year.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s10151-022-02593-1","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T11:11:24Z","timestamp":1645787484000},"page":"453-459","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Long-term outcomes of an acellular dermal matrix for the treatment of complex cryptoglandular anal fistula: a pilot study"],"prefix":"10.1007","volume":"26","author":[{"given":"M. J.","family":"G\u00f3mez-Jurado","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Mart\u00ed-Gallostra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8322-6421","authenticated-orcid":false,"given":"G.","family":"Pellino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Galvez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Kreisler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Biondo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Esp\u00edn-Basany","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"2593_CR1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1177\/014107688407700506","volume":"77","author":"M Khubchandani","year":"1984","unstructured":"Khubchandani M (1984) Comparison of results of treatment of fistula-in-ano. J R Soc Med 77:369\u2013371","journal-title":"J R Soc Med"},{"key":"2593_CR2","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1007\/s10350-008-9374-5","volume":"51","author":"D Christoforidis","year":"2008","unstructured":"Christoforidis D, Etzioni DA, Goldberg SM, Madoff RD, Mellgren A (2008) Treatment of complex anal fistulas with the collagen fistula plug. Dis Colon Rectum 51:1482\u20131487","journal-title":"Dis Colon Rectum"},{"key":"2593_CR3","first-page":"30","volume":"15","author":"SK Narang","year":"2017","unstructured":"Narang SK, Keogh K, Alam NN, Pathak S, Daniels IR, Smart NJ (2017) A systematic review of new treatments for cryptoglandular fistula in ano. Surg J R Coll Surg Edinb Irel 15:30\u201339","journal-title":"Surg J R Coll Surg Edinb Irel"},{"key":"2593_CR4","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1007\/BF02054434","volume":"39","author":"J Garcia-Aguilar","year":"1996","unstructured":"Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723\u2013729","journal-title":"Dis Colon Rectum"},{"key":"2593_CR5","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1007\/DCR.0b013e3181d43b7d","volume":"53","author":"CN Ellis","year":"2010","unstructured":"Ellis CN, Rostas JW, Greiner FG (2010) Long-term outcomes with the use of bioprosthetic plugs for the management of complex anal fistulas. Dis Colon Rectum 53:798\u2013802","journal-title":"Dis Colon Rectum"},{"key":"2593_CR6","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1097\/DCR.0b013e31822c5398","volume":"54","author":"JG Han","year":"2011","unstructured":"Han JG, Wang ZJ, Zhao BC, Zheng Y, Zhao B, Yi BQ et al (2011) Long-term outcomes of human acellular dermal matrix plug in closure of complex anal fistulas with a single tract. Dis Colon Rectum 54:1412\u20131418","journal-title":"Dis Colon Rectum"},{"key":"2593_CR7","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1007\/s00384-017-2779-7","volume":"32","author":"Z Balciscueta","year":"2017","unstructured":"Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, Garc\u00eda-Granero E (2017) Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis 32:599\u2013609","journal-title":"Int J Colorectal Dis"},{"key":"2593_CR8","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1002\/bjs.6613","volume":"96","author":"H Ortiz","year":"2009","unstructured":"Ortiz H, Marzo J, Ciga MA, Oteiza F, Armend\u00e1riz P, de Miguel M (2009) Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano. Br J Surg 96:608\u2013612","journal-title":"Br J Surg"},{"key":"2593_CR9","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ijso.2018.10.007","volume":"15","author":"T Schwandner","year":"2018","unstructured":"Schwandner T, Thieme A, Scherer R, Hodde JP, S\u00f6tje U, Roblick M et al (2018) Randomized clinical trial comparing a small intestinal submucosa anal fistula plug to advancement flap for the repair of complex anal fistulas. Int J Surg Open 15:25\u201331","journal-title":"Int J Surg Open"},{"key":"2593_CR10","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1007\/s00384-010-0993-7","volume":"25","author":"LE Mitalas","year":"2010","unstructured":"Mitalas LE, van Wijk JJ, Gosselink MP, Doornebosch P, Zimmerman DDE, Schouten WR (2010) Seton drainage prior to transanal advancement flap repair: useful or not? Int J Colorectal Dis 25:1499\u20131502","journal-title":"Int J Colorectal Dis"},{"key":"2593_CR11","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/bjs5.50129","volume":"3","author":"ME Stellingwerf","year":"2019","unstructured":"Stellingwerf ME, van Praag EM, Tozer PJ, Bemelman WA, Buskens CJ (2019) Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn\u2019s high perianal fistulas. BJS Open 3:231\u2013241","journal-title":"BJS Open"},{"key":"2593_CR12","doi-asserted-by":"publisher","first-page":"3279","DOI":"10.3748\/wjg.v16.i26.3279","volume":"16","author":"M-M-T-J A ba-bai-ke-re","year":"2010","unstructured":"A ba-bai-ke-re M-M-T-J, Wen H, Huang H-G, Chu H, Lu M, Chang Z-S et al (2010) Randomized controlled trial of minimally invasive surgery using acellular dermal matrix for complex anorectal fistula. World J Gastroenterol 16:3279\u20133286","journal-title":"World J Gastroenterol"},{"key":"2593_CR13","doi-asserted-by":"publisher","first-page":"4791","DOI":"10.3748\/wjg.14.4791","volume":"14","author":"W-L Song","year":"2008","unstructured":"Song W-L, Wang Z-J, Zheng Y, Yang X-Q, Peng Y-P (2008) An anorectal fistula treatment with acellular extracellular matrix: a new technique. World J Gastroenterol 14:4791\u20134794","journal-title":"World J Gastroenterol"},{"key":"2593_CR14","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s10350-005-0288-1","volume":"49","author":"EK Johnson","year":"2006","unstructured":"Johnson EK, Gaw JU, Armstrong DN (2006) Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum 49:371\u2013376","journal-title":"Dis Colon Rectum"},{"key":"2593_CR15","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1007\/s00268-008-9504-1","volume":"32","author":"DA Lawes","year":"2008","unstructured":"Lawes DA, Efron JE, Abbas M, Heppell J, Young-Fadok TM (2008) Early experience with the bioabsorbable anal fistula plug. World J Surg 32:1157\u20131159","journal-title":"World J Surg"},{"key":"2593_CR16","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1007\/DCR.0b013e31819d473f","volume":"52","author":"JY Wang","year":"2009","unstructured":"Wang JY, Garcia-Aguilar J, Sternberg JA, Abel ME, Varma MG (2009) Treatment of transsphincteric anal fistulas: are fistula plugs an acceptable alternative? Dis Colon Rectum 52:692\u2013697","journal-title":"Dis Colon Rectum"},{"key":"2593_CR17","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.cursur.2006.07.005","volume":"64","author":"CN Ellis","year":"2007","unstructured":"Ellis CN (2007) Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ 64:36\u201340","journal-title":"J Surg Educ"},{"key":"2593_CR18","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344\u2013349","journal-title":"J Clin Epidemiol"},{"key":"2593_CR19","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1136\/bmj.1.5224.463","volume":"5224","author":"AG Parks","year":"1961","unstructured":"Parks AG (1961) Pathogenesis and treatment of fistuila-in-ano. Br Med J 5224:463\u2013469","journal-title":"Br Med J"}],"container-title":["Techniques in Coloproctology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-022-02593-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10151-022-02593-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-022-02593-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T22:32:14Z","timestamp":1674858734000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10151-022-02593-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,25]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["2593"],"URL":"https:\/\/doi.org\/10.1007\/s10151-022-02593-1","relation":{},"ISSN":["1123-6337","1128-045X"],"issn-type":[{"value":"1123-6337","type":"print"},{"value":"1128-045X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,25]]},"assertion":[{"value":"14 November 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study complied with the Declaration of Helsinki statement. All patients provided written informed consent before receiving the procedures.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical and informed consent"}}]}}