Table 2.
Surgical techniques used in the studies included in the systematic review of Garg et al. (13).
| Reference | Surgical technique |
|---|---|
| Johnson et al. (11) | Self made SIS-anal-fistula plug from a 2 cm × 3 cm SIS – sheet rolled into a conical configuration |
| Plug was pulled tip-first into the internal opening | |
| Suture fixation of the plug at the primary and secondary opening | |
| Plug was trimmed at the mucosa and skin level | |
| No complete occlusion of the secondary opening to allow drainage | |
| O’Connor et al. (14) | Tracts were irrigated with hydrogen peroxide |
| SIS-anal-fistula plug | |
| Plug was pulled tip-first into the internal opening | |
| Excess plug material was trimmed flush with the mucosa and skin | |
| Suture fixation of the plug at the primary and secondary opening | |
| Case was taken not to occlude the secondary opening | |
| Champagne et al (15) | Hydrogen-peroxide installation |
| SIS-anal-fistula plug | |
| Plug was pulled tip-first into the internal opening | |
| Excess plug material was trimmed flush with the primary opening | |
| Mechanical stability of the plug relies on firmly suturing the head of the plug into the primary opening | |
| Fixation of the tip of the plug to the edge of the secondary opening | |
| No complete occlusion of the secondary opening to allow drainage | |
| Ellis (21) | Hydrogen-peroxide installation |
| SIS-anal-fistula plug | |
| No debridement of the fistula tract was performed | |
| Occasionally, the distal most portion of the fistula tract was opened to ensure adequate drainage | |
| van Koperen (16) | Cleaning with hydrogen peroxide |
| SIS-anal-fistula plug | |
| No surgical debridement | |
| Remaining portion of the plug was removed | |
| Plug fixation at the internal and external opening | |
| The external fistula opening was not completely closed, enabling further drainage from the fistula tract | |
| Tract was irrigated with polyhexamide solution | |
| Schwandner et al. (17) | SIS-anal-fistula plug |
| No currettage, mechanical debridement, or fistulectomy was performed | |
| Plug was pulled tip-first into the internal opening | |
| Plug fixation at the internal opening | |
| The excess plug was trimmed at the mucosa and the former internal opening was covered with mucosa | |
| Finally, the excess plug material of the external opening was trimmend at skin level, but no further fixation was made | |
| Ky et al. (18) | SIS-anal-fistula plug |
| Plug was pulled tail-first into the internal opening | |
| Excess plug material was trimmed flush at the internal opening with the mucosa | |
| Plug was sutured deep to the internal opening | |
| A small mucosal flap was raised as advancement flap over the top of the plug | |
| Excess material protruding the external opening was excised | |
| The secondary opening was left open to allow drainage | |
| Lawes et al. (22) | Tract was washed out with hydrogen peroxide |
| SIS-anal-fistula plug | |
| Plug was pulled tip-first into the internal opening | |
| Excess plug material was trimmed flush with the internal and external opening | |
| Suture fixation to the mucosa and internal sphincter | |
| Christoforidis et al. (23) | SIS-anal-fistula plug |
| Plug was pulled through the internal opening | |
| Plug was secured at the internal opening | |
| The excess plug was trimmed of and the rectal mucosa was closed over the plug | |
| The plug was trimmed flush with the skin | |
| It was then secured with a stitch on one side of the external opening (15 procedures) or left unsecured (49 procedures) | |
| Thekkinkattil et al. (19) | Tract was irrigated with saline or hydrogen peroxide |
| SIS-anal-fistula plug | |
| The fistula plug was inserted from the internal opening | |
| The rectal mucosa was closed over the plug at the internal opening along with a deep suture through the internal sphincter | |
| Special attention has been made so ensure that the external opening was not completely occluded | |
| Garg (20) | SIS-anal-fistula plug |
| Plug was pulled through the track from the internal opening | |
| Any excess plug was cut flush with the internal opening | |
| The internal opening was then closed over the plug including the submucosa and internal sphincter muscle | |
| The distal end of the plug was sutered to the side of the external opening taking, care not to occlude it and allow drainage |