{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:11:46Z","timestamp":1780963906654,"version":"3.54.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2008,6,23]],"date-time":"2008-06-23T00:00:00Z","timestamp":1214179200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2008,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Low transsphincteric fistulas less than 1\/3 of the sphincter complex are easy to treat by fistulotomy with a high success rate. High transsphincteric fistulas remain a surgical challenge. Various surgical procedures are available, but recurrence rates of these techniques are disappointingly high. The mucosal flap advancement is considered the gold standard for the treatment of high perianal fistula of cryptoglandular origin by most colorectal surgeons. In the literature a recurrence rate between 0 and 63% is reported for the mucosal flap advancement. Recently Armstrong and colleagues reported on a new biologic anal fistula plug, a bioabsorbable xenograft made of lyophilized porcine intestinal submucosa. Their prospective series of 15 patients with high perianal fistula treated with the anal fistula plug showed promising results.<\/jats:p>\n            <jats:p>The anal fistula plug trial is designed to compare the anal fistula plug with the mucosal flap advancement in the treatment of high perianal fistula in terms of success rate, continence, postoperative pain, and quality of life.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\/design<\/jats:title>\n            <jats:p>The PLUG trial is a randomized controlled multicenter trial. Sixty patients with high perianal fistulas of cryptoglandular origin will be randomized to either the fistula plug or the mucosal advancement flap. Study parameters will be anorectal fistula closure-rate, continence, post-operative pain, and quality of life. Patients will be followed-up at two weeks, four weeks, and 16 weeks. At the final follow-up closure rate is determined by clinical examination by a surgeon blinded for the intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion<\/jats:title>\n            <jats:p>Before broadly implementing the anal fistula plug results of randomized trials using the plug should be awaited. This randomized controlled trial comparing the anal fistula plug and the mucosal advancement flap should provide evidence regarding the effectiveness of the anal fistula plug in the treatment of high perianal fistulas.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>\n              <jats:bold>ISRCTN:<\/jats:bold> 97376902<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2482-8-11","type":"journal-article","created":{"date-parts":[[2008,6,24]],"date-time":"2008-06-24T06:13:27Z","timestamp":1214288007000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["The Anal Fistula Plug versus the mucosal advancement flap for the treatment of Anorectal Fistula (PLUG trial)"],"prefix":"10.1186","volume":"8","author":[{"given":"Paul J","family":"van Koperen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem A","family":"Bemelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick MM","family":"Bossuyt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F","family":"Gerhards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quirijn AJ","family":"Eijsbouts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem F","family":"van Tets","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas WM","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F Robert","family":"Dijkstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette D","family":"van Dalsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Frederik M","family":"Slors","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2008,6,23]]},"reference":[{"issue":"4","key":"116_CR1","first-page":"219","volume":"73","author":"P Sainio","year":"1984","unstructured":"Sainio P: Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984, 73 (4): 219-24.","journal-title":"Ann Chir Gynaecol"},{"issue":"2","key":"116_CR2","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1002\/bjs.1800640203","volume":"64","author":"CG Marks","year":"1977","unstructured":"Marks CG, Ritchie JK: Anal fistulas at St Mark's Hospital. Br J Surg. 1977, 64 (2): 84-91. 10.1002\/bjs.1800640203.","journal-title":"Br J Surg"},{"issue":"5224","key":"116_CR3","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1136\/bmj.1.5224.463","volume":"1","author":"AG Parks","year":"1961","unstructured":"Parks AG: Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961, 1 (5224): 463-9.","journal-title":"Br Med J"},{"issue":"1","key":"116_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/bjs.1800630102","volume":"63","author":"AG Parks","year":"1976","unstructured":"Parks AG, Gordon PH, Hardcastle JD: A classification of fistula-in-ano. Br J Surg. 1976, 63 (1): 1-12. 10.1002\/bjs.1800630102.","journal-title":"Br J Surg"},{"issue":"12","key":"116_CR5","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1046\/j.1365-2168.2000.01582.x","volume":"87","author":"H Ortiz","year":"2000","unstructured":"Ortiz H, Marzo J: Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas. Br J Surg. 2000, 87 (12): 1680-3. 10.1046\/j.1365-2168.2000.01582.x.","journal-title":"Br J Surg"},{"issue":"8","key":"116_CR6","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1007\/s00384-005-0072-7","volume":"21","author":"SJ van der Hagen","year":"2006","unstructured":"Hagen van der SJ, Baeten CG, Soeters PB, van Gemert WG: Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: Recurrent perianal fistulas: failure of treatment or recurrent patient disease?. Int J Colorectal Dis. 2006, 21 (8): 784-90. 10.1007\/s00384-005-0072-7.","journal-title":"Int J Colorectal Dis"},{"issue":"4","key":"116_CR7","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1002\/bjs.4466","volume":"91","author":"GN Buchanan","year":"2004","unstructured":"Buchanan GN, Owen HA, Torkington J: Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula. Br J Surg. 2004, 91 (4): 476-80. 10.1002\/bjs.4466.","journal-title":"Br J Surg"},{"issue":"2","key":"116_CR8","first-page":"136","volume":"88","author":"P Aitola","year":"1999","unstructured":"Aitola P, Hiltunen KM, Matikainen M: Fibrin glue in perianal fistulas \u2013 a pilot study. Ann Chir Gynaecol. 1999, 88 (2): 136-8.","journal-title":"Ann Chir Gynaecol"},{"issue":"9","key":"116_CR9","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1007\/s10350-004-6708-9","volume":"46","author":"GN Buchanan","year":"2003","unstructured":"Buchanan GN, Bartram CI, Phillips RK: Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum. 2003, 46 (9): 1167-74. 10.1007\/s10350-004-6708-9.","journal-title":"Dis Colon Rectum"},{"issue":"11","key":"116_CR10","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1007\/s10350-006-0718-8","volume":"49","author":"CN Ellis","year":"2006","unstructured":"Ellis CN, Clark S: Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study. Dis Colon Rectum. 2006, 49 (11): 1736-40. 10.1007\/s10350-006-0718-8.","journal-title":"Dis Colon Rectum"},{"issue":"2","key":"116_CR11","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/S1091-255X(01)80028-7","volume":"5","author":"SM Sentovich","year":"2001","unstructured":"Sentovich SM: Fibrin glue for all anal fistulas. J Gastrointest Surg. 2001, 5 (2): 158-61. 10.1016\/S1091-255X(01)80028-7.","journal-title":"J Gastrointest Surg"},{"issue":"4","key":"116_CR12","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1007\/s10350-004-6589-y","volume":"46","author":"SM Sentovich","year":"2003","unstructured":"Sentovich SM: Fibrin glue for anal fistulas: long-term results. Dis Colon Rectum. 2003, 46 (4): 498-502. 10.1007\/s10350-004-6589-y.","journal-title":"Dis Colon Rectum"},{"issue":"Suppl 4","key":"116_CR13","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/j.1463-1318.2007.01372.x","volume":"9","author":"JG Williams","year":"2007","unstructured":"Williams JG, Farrands PA, Williams AB: The treatment of anal fistula: ACPGBI position statement. Colorectal Dis. 2007, 9 (Suppl 4): 18-50. 10.1111\/j.1463-1318.2007.01372.x.","journal-title":"Colorectal Dis"},{"issue":"1\u20132","key":"116_CR14","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1159\/000085299","volume":"22","author":"SS Gisbertz","year":"2005","unstructured":"Gisbertz SS, Sosef MN, Festen S, Gerhards MF: Treatment of fistulas in ano with fibrin glue. Dig Surg. 2005, 22 (1\u20132): 91-4. 10.1159\/000085299.","journal-title":"Dig Surg"},{"issue":"5","key":"116_CR15","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1111\/j.1463-1318.2004.00676.x","volume":"6","author":"TM Hammond","year":"2004","unstructured":"Hammond TM, Grahn MF, Lunniss PJ: Fibrin glue in the management of anal fistulae. Colorectal Dis. 2004, 6 (5): 308-19. 10.1111\/j.1463-1318.2004.00676.x.","journal-title":"Colorectal Dis"},{"issue":"3","key":"116_CR16","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: Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006, 49 (3): 371-6. 10.1007\/s10350-005-0288-1.","journal-title":"Dis Colon Rectum"},{"issue":"2","key":"116_CR17","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1007\/s00384-004-0638-9","volume":"20","author":"R Bakx","year":"2005","unstructured":"Bakx R, Sprangers MA, Oort FJ: Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis. 2005, 20 (2): 126-36. 10.1007\/s00384-004-0638-9.","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"116_CR18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1136\/gut.44.1.77","volume":"44","author":"CJ Vaizey","year":"1999","unstructured":"Vaizey CJ, Carapeti E, Cahill JA, Kamm MA: Prospective comparison of faecal incontinence grading systems. Gut. 1999, 44 (1): 77-80.","journal-title":"Gut"},{"issue":"12","key":"116_CR19","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1002\/bjs.1800721211","volume":"72","author":"O Kronborg","year":"1985","unstructured":"Kronborg O: To lay open or excise a fistula-in-ano: a randomized trial. Br J Surg. 1985, 72 (12): 970-10.1002\/bjs.1800721211.","journal-title":"Br J Surg"},{"issue":"2","key":"116_CR20","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/BF01648418","volume":"1","author":"PJ Shouler","year":"1986","unstructured":"Shouler PJ, Grimley RP, Keighley MR, exander-Williams J: Fistula-in-ano is usually simple to manage surgically. Int J Colorectal Dis. 1986, 1 (2): 113-5. 10.1007\/BF01648418.","journal-title":"Int J Colorectal Dis"},{"issue":"12","key":"116_CR21","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1007\/s10350-006-0755-3","volume":"49","author":"BJ Champagne","year":"2006","unstructured":"Champagne BJ, O'Connor LM, Ferguson M: Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum. 2006, 49 (12): 1817-21. 10.1007\/s10350-006-0755-3.","journal-title":"Dis Colon Rectum"},{"issue":"1","key":"116_CR22","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: Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ. 2007, 64 (1): 36-40. 10.1016\/j.cursur.2006.07.005.","journal-title":"J Surg Educ"},{"issue":"10","key":"116_CR23","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1007\/s10350-006-0695-y","volume":"49","author":"L O'Connor","year":"2006","unstructured":"O'Connor L, Champagne BJ, Ferguson MA: Efficacy of anal fistula plug in closure of Crohn's anorectal fistulas. Dis Colon Rectum. 2006, 49 (10): 1569-73. 10.1007\/s10350-006-0695-y.","journal-title":"Dis Colon Rectum"},{"issue":"12","key":"116_CR24","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.1007\/s10350-007-0298-2","volume":"50","author":"PJ van Koperen","year":"2007","unstructured":"van Koperen PJ, D'Hoore A, Wolthuis AM, Bemelman WA, Slors JF: Anal fistula plug for closure of difficult anorectal fistula: a prospective study. Dis Colon Rectum. 2007, 50 (12): 2168-72. 10.1007\/s10350-007-0298-2.","journal-title":"Dis Colon Rectum"},{"key":"116_CR25","volume-title":"Dis Colon Rectum","author":"PJ Van Koperen","year":"2008","unstructured":"Van Koperen PJ, Wind J, Bemelman WA: Long term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas. Dis Colon Rectum. 2008,"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2482-8-11.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2482-8-11\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2482-8-11","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2482-8-11.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T08:57:05Z","timestamp":1630486625000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/1471-2482-8-11"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,6,23]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2008,12]]}},"alternative-id":["116"],"URL":"https:\/\/doi.org\/10.1186\/1471-2482-8-11","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,6,23]]},"assertion":[{"value":"20 May 2008","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2008","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2008","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"11"}}