Anal Fistula treatment options & economics: Dr. Philip Pearson

The numbers are really abysmal. You’ve seen these before, but the plug that I thought was so exciting has over a 55% failure rate. The LIFT that I started doing in practice in the first five years also had a pretty terrible failure rate. Sometimes quoted as 40%, sometimes 50%.

Jeff talked about the advancement flaps, and people are introducing all kinds of biologic compounds to try and support their results for the flaps, but the flap failure is pretty high.

I never personally had even heard about a laser treatment, but I met three very nice folks from Brazil yesterday, and they use the laser in Brazil, and they don’t even like the laser very much. Very high failure rate.

So, if you look at the failure rates and you look at the BioHealx failure rate, you’re just looking at fewer procedures. A 16% failure rate for BioHealx just means many fewer people going back to the OR.

All these other techniques, wonderful though they are to preserve the sphincter with the super high recurrence rates, are just bringing people back to the OR. It’s your time and their money and their insurance company’s money.

Fun little formula here. If you pick a procedure with a failure rate and you know it’s going to fail and you’re going to have to take them back, do a little intellectual exercise to say, well, how many times do you have to take that person back to have it actually work?

It’s like 100 divided by one minus the failure rate. You wouldn’t actually do the same exact procedure probably 10 times, but it’s a little intellectual exploration. How many procedures would you need to do, to cure 100 people?

And so, for the flap, it’s 154 times you would have to do a procedure to cure 100 people. And it goes up from there up to the plug: 222 procedures to fix 100 people, which seems ridiculous. And with our lower recurrence rate than the data so far for BioHealx, it’s only 119 procedures to cure 100 people.