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Journal of Gastrointestinal Surgery

, Volume 23, Issue 5, pp 1030–1036 | Cite as

Can Perianal Fistula Be Treated Non-surgically with Platelet-Rich Fibrin Sealant?

  • Francisco Javier Pérez LaraEmail author
  • Jose Manuel Hernández González
  • Arminda Ferrer Berges
  • Isabel Navarro Gallego
  • Herman Oehling de los Reyes
  • Horacio Oliva Muñoz
Original Article

Abstract

Introduction

In the last 20 years, various procedures have been suggested for the treatment of anal fistula whilst minimising anal sphincter injury and preserving optimal function. Since 2011, patients at our hospital have been treated for anal fistula by means of platelet-rich fibrin plugs. To do so, three different application techniques have been used, the most recent of which is a non-surgical approach. In this paper, we compare and contrast the results obtained by each of these three techniques.

Material and Method

This study compares three procedures in which the anal fistula was sealed using platelet-rich fibrin: for the patients in group A, the plug was surgically inserted, under anaesthesia, and traditional methods were used to curette the fistula tract and close the internal orifice; for those in group B, the plug was surgically inserted, under anaesthesia, after curettage of the fistula tract using a graduated set of cylindrical curettes, and the internal orifice was closed as before; and for those in group C, the plug was inserted during outpatient consultation, without anaesthesia, without curettage and without closure of the internal orifice.

Results

The patients in the three groups were homogeneous in terms of sex, age, ASA classification, location of the fistula and previous insertion of the seton. There were no significant differences in morbidity or postoperative continence. However, there was a statistically significant difference in the outcomes achieved, in favour of group B, while groups A and C obtained similar results.

Conclusions

Outpatient treatment of perianal fistula is totally innocuous. It is a very low cost procedure and the results obtained are highly acceptable (similar to those of the surgical insertion of a plug, with traditional curettage). Therefore, we believe this approach should be considered a valid initial treatment for perianal fistula, reserving surgical treatment (curettage and sealing using a cylindrical-curette kit) for cases in which this initial method is unsuccessful. This would avoid many complications and achieve considerable financial savings for the health system.

Keywords

Anal fistula Non-surgical treatment 

Notes

Authors Contributions

FJ Pérez Lara made a substantial contribution to the concept and design, drafted the article or revised it critically for important intellectual content, and approved the version to be published. JM Hernández Gonzalez approved the version to be published. A Ferrer Berges approved the version to be published. I. Navarro Gallego approved the version to be published. H Oehling de los Reyes approved the version to be published. H Oliva Muñoz approved the version to be published.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Francisco Javier Pérez Lara
    • 1
    Email author
  • Jose Manuel Hernández González
    • 1
  • Arminda Ferrer Berges
    • 2
  • Isabel Navarro Gallego
    • 3
  • Herman Oehling de los Reyes
    • 1
  • Horacio Oliva Muñoz
    • 2
  1. 1.Antequera HospitalMálagaSpain
  2. 2.Malaga Universitary HosptialMálagaSpain
  3. 3.Antequera HospitalMálagaSpain

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