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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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References

  1. Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J 1961;1(5224):463–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Parés D. Pathogenesis and treatment of fistula in ano. Br J Surg 2011;98(1):2–3.

    Article  PubMed  Google Scholar 

  3. Bannura G. Fístula anOrrectal. ¿sOn las técnicas nueVas suPeriOres a las clásicas?. Rev Chil Cir. 2015;67(4):430–440.

    Article  Google Scholar 

  4. Philips RKS, Lunnis P. Anal fistula: Surgical evaluation and management. Londres; 1996.

    Google Scholar 

  5. Lunniss PJ, Kamm MA, Phillips RK. Factors affecting continence after surgery for anal fistula. Br J Surg. 1994;81(9):1382–5.

    Article  CAS  PubMed  Google Scholar 

  6. Hammond TM, Knowles CH, Porrett T, Lunniss PJ. The Snug Seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae. Colorectal Dis. 2006;8(4):328–37.

    Article  CAS  PubMed  Google Scholar 

  7. Dziki A, Bartos M. Seton treatment of anal fistula: experience with a new modification. Eur J Surg. 1998;164(7):543–8.

    Article  CAS  PubMed  Google Scholar 

  8. Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow-Choen F. Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon rectum. 1997;40(12):1435–8.

  9. Byrne CM, Solomon MJ. The Use of Setons in Fistula-in-Ano. Semin ColonRectalSurg. 2009;20(1):10–7.

    Google Scholar 

  10. van Koperen PJ, Wind J, Bemelman WA, Bakx R, Reitsma JB, Slors JF. Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon rectum. 2008;51(10):1475–81.

  11. Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP. Outcome after incision and drainage with fistulotomy for ischiorectal abscess. Am Surg. 1997;63(8):686–9.

    CAS  PubMed  Google Scholar 

  12. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hjortrup A, Moesgaard F, Kjaergard J. Fibrin adhesive in the treatment of perineal fistulas. Dis Colon rectum. 1991;34(9):752–4.

  14. Champagne BJ, O’Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon rectum. 2006;49(12):1817–21.

  15. Herreros MD, Garcia-Arranz M, Guadalajara H, De-La-Quintana P, Garcia-Olmo D, Fatt Collaborative Group. Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula Advanced Therapy Trial 1) and long-term evaluation. Dis Colon Rectum. 2012;55(7):762–72.

    Article  CAS  PubMed  Google Scholar 

  16. Prosst RL, Herold A, Joos AK, Bussen D, Wehrmann M, Gottwald T, et al. The anal fistula claw: the OTSC clip for anal fistula closure. Colorectal Dis. 2012;14(9):1112–7.

    Article  CAS  PubMed  Google Scholar 

  17. Méndez R, López-Cedrún JL, Patiño B, et al. Plasma enriquecido en plaquetas en la alveoloplastia de pacientes fisurados. Cir Pediatr 2006;19:23–6.

    PubMed  Google Scholar 

  18. Tansley P, Al-Mulhim F, Lim E, et al. A prospective, randomized, controlled trial of the effectiveness of BioGlue in treating alveolar air leaks. J Thorac Cardiovasc Surg 2006;132:105–12. https://doi.org/10.1016/j.jtcvs.2006.02.022

    Article  PubMed  Google Scholar 

  19. Rousou J. Use of fibrin sealants in cardiovascular surgery. J Card Surg 2013;28:238–47. https://doi.org/10.1111/jocs.12099

    Article  PubMed  Google Scholar 

  20. Rodríguez Flores J, Palomar Gallego A, García-Denche J. Plasma rico en plaquetas: fundamentos biológicos y aplicaciones en cirugía maxilofacial y estética facial. Cirugía Oral y Maxilofacial 2012;34:8–17. https://doi.org/10.1016/j.maxilo.2011.10.007

    Article  Google Scholar 

  21. Frei R, Biosca FE, Handl M, et al. Conservative treatment using plasma rich in growth factors (PRGF) for injury to the ligamentous complex of the ankle. Acta Chir Orthop Traumatol Cech 2008;75:28–33.

    CAS  PubMed  Google Scholar 

  22. Pérez Lara FJ, Serrano AM, Moreno JU, et al. Platelet-rich fibrin sealant as a treatment for complex perianal fistulas: A multicentre study. J Gastrointest Surg 2015;19: 360–8.

    Article  Google Scholar 

  23. Buchanan GN, Sibbons P, Osborn M, Bartram CI, Ansari T, Halligan S, et al. Pilot study: fibrin sealant in anal fistula model. Dis Colon Rectum. 2005;48(3):532–9.

  24. Perez Lara FJ, Hernandez Carmona JM, Del Rey Moreno A, Oliva Munoz H. Cylindrical curettes for the treatment of complex perianal fistulas. Dis Colon Rectum. 2014;57(9):1140.

    Article  PubMed  Google Scholar 

  25. Perez Lara FJ, Ferrer Berges A, Hernandez González JM, Sanchis Cárdenas E, Del Rey Moreno A, Oliva Munoz H. Method for Management of Perianal Fistula with New Device: Progressive Curettage of the Tract and Sealing with Platelet-Rich Fibrin. Ann Colorectal Res. 2016;4(3):e37452.

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Authors and Affiliations

  1. Antequera Hospital, Avda Poeta Muñoz Rojas sn, C.P, 29200, Málaga, Spain

    Francisco Javier Pérez Lara, Jose Manuel Hernández González & Herman Oehling de los Reyes

  2. Malaga Universitary Hosptial, Málaga, Spain

    Arminda Ferrer Berges & Horacio Oliva Muñoz

  3. Antequera Hospital, Málaga, Spain

    Isabel Navarro Gallego

Authors
  1. Francisco Javier Pérez Lara
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  2. Jose Manuel Hernández González
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  3. Arminda Ferrer Berges
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  4. Isabel Navarro Gallego
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  5. Herman Oehling de los Reyes
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  6. Horacio Oliva Muñoz
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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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Correspondence to Francisco Javier Pérez Lara.

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Pérez Lara, F.J., Hernández González, J.M., Ferrer Berges, A. et al. Can Perianal Fistula Be Treated Non-surgically with Platelet-Rich Fibrin Sealant?. J Gastrointest Surg 23, 1030–1036 (2019). https://doi.org/10.1007/s11605-018-3932-5

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  • DOI: https://doi.org/10.1007/s11605-018-3932-5

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