Long-term Efficacy of the Button Fistula Plug in the Treatment of Ileal Pouch-vaginal and Crohn's-related Rectovaginal Fistulas

Abstract

Several new techniques have been described for the management of anal fistulas. The anal fistula plug has received much attention. The button plug adaptation has been heralded for use in rectovaginal and ileal pouch-vaginal fistulas. The aim of this study was to report the long-term efficacy of the button plug in patients with such fistulas. All women with ileal pouch-vaginal and rectovaginal fistulas secondary to Crohn's disease who underwent insertion of a novel button fistula plug between May 2008 and November 2009 were prospectively evaluated. At long-term follow up of a median of 118 (interquartile range, 81.5-129.0) weeks, none of the 11 patients (0%) with ileal pouch-vaginal fistulas were considered to have healed, whereas 4 of the 9 patients (44%) with rectovaginal fistulas had healed. Each of these 4 patients whose treatment was successful were nonsmokers with an etiology of Crohn's disease and achieved complete closure of the fistula tract after one procedure, and none had been defunctioned. All repeat procedures failed. The button fistula plug may be an option for patients with Crohn's-related rectovaginal fistulas, albeit with the caveat of advising patients of a less than 50% success rate, but not for patients with ileal pouch-vaginal fistulas. Repeat attempts cannot be justified.