Anal fistula plug: Where were we, where are we now?

The controversy associated with the treatment of complex fistula disease is rooted within the balance of the therapeutic index—highly efficacious techniques, such as fistulotomy, have unfavorably high rates in incontinence. Unfortunately, safer techniques, such as fibrin glue and anal fistula plugs sacrifice better cure rates for lower rates of post-operative incontinence. This article will discuss the use of the anal fistula plug (AFP) from its inception, evolution of technique, and its predictors of success, while summarizing the literature on the bioprosthetic anal fistula plugs in the management of anal fistulas.