Permacol™ collagen paste for cryptoglandular and Crohn’s anal fistula

  • M. Brunner
  • I. Schneider
  • K. Günther
  • R. Grützmann
  • K. E. MatzelEmail author
Original Article



Permacol™ collagen paste, an acellular crosslinked porcine dermal collagen matrix suspension, is a new treatment option for anal fistula. Data remain limited, however, and as yet only the results of one case of Crohn’s fistula treated with Permacol™ paste has been reported. The aim of this study was to assess the use of Permacol™ collagen paste in patients with cryptoglandular and Crohn’s perianal fistulae.


A prospective study was conducted on patients with anal fistula, treated with Permacol™ paste. Patients were followed at 1 week, 6 and 12 months, and on demand thereafter. The main focus was on fistula healing and postoperative continence. The former was defined as the absence of signs of recurrence on clinical examination, proctoscopy and rigid rectoscopy. Fecal incontinence was assessed before surgery and at each follow-up.


Thirty patients (19 women, 11 men; mean age 46 years), 12 (40%) of whom had Crohn’s disease were included. The average number of previous fistula operations was 6. All patients had ≥ 6 months of follow-up, and 24 patients (80%) had ≥ 12 months of follow-up. The healing rate in all patients was 57% (17 of 30 patients) at 6 months and 63% (15 of 24 patients) at 12 months. One patient reported a worsening of fecal incontinence at 12 months; 2 patients had adverse events (perianal pain: n = 1, fluid accumulation n = 1) requiring fistula drainage. Patient characteristics, healing, incontinence, and adverse events did not differ significantly between patients with and without Crohn’s disease.


Our data indicate that Permacol™ paste is a safe and moderately effective treatment for cryptoglandular and Crohn’s fistulae.


Anal fistula Collagen Fistula treatment Anal sphincter Minimally invasive surgical procedures Crohn’s disease 


Compliance with ethical standards

Conflict of interest

K.E. Matzel is medical adviser to Medtronic. M. Brunner has received an honorarium for lecturing at a Medtronic workshop.

Ethical approval

This report contains no animal studies.

Informed consent

For this type of study, formal consent is not required, as this report contains no identifying patient information.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of General and Visceral SurgeryFriedrich-Alexander-UniversityErlangenGermany
  2. 2.Department of General and Visceral SurgeryHospital HallerwieseNurembergGermany

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