The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on closure of anal fistula using a suturable bioprosthetic plug in November 2011. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
Status In progress
Process IP
ID number 3783
Description Bioprosthetic plug insertion for anal fistula aims to leave the sphincter muscles intact, allowing the use of subsequent treatments if needed. The procedure is usually done using general anaesthesia. The fistula tract is identified using a probe or by imaging techniques, and it may be irrigated. A conical plug, usually made of porcine intestinal submucosa, is pulled into the tract until it blocks the internal opening. It is sutured in place at the internal opening. The external opening is not completely sealed so that drainage of the fistula can continue. The plug acts as a scaffold into which new tissue can grow. More than 1 device is available for this procedure.

Provisional Schedule

Expected publication 25 September 2019


Key events during the development of the guidance:

Date Update
24 April 2019 - 23 May 2019 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance