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Background There is a need for other than surgical methods of therapy for small and low rectovaginal fistulas (RVF) in the course of inflammatory bowel diseases (IBD), such as application of fibrin sealants, stem cells, biological therapy, or platelet-rich plasma. The aim of this study was to evaluate the results of the treatment after local application of PRP in aforementioned fistulas, exclusively in the patients with ulcerative colitis (UC). Patients and methods Medical records of 13 patients with small and low-lying, active RVF in the course of UC, and after restorative proctocolectomy for UC were evaluated. Curettage of fistulous tracts was performed with the following application of PRP in all patients. Results Complete closure of RVF was achieved after the first injection in 4 patients, 3 women healed their fistulas following the second application, and two of them closed RVF after 3 injections. To sum up, the complete closure of RVF was achieved in 9 (69%) patients. Fistulas remained closed from 6 to 12 months. Conclusions The application of PRP in small, low, and recurrent IBD anal fistulas is effective, simple, and safe with an acceptable rate of healing. This therapy might also precede any further, surgical methods of treatment.

EDITORIALAbstract-Hard-to-heal wounds continue to be a challenge in the everyday surgical practice. Their treatment is timeconsuming, expensive and in many cases requires interdisciplinary assessment. Therapy option include properly selected surgical procedures and dressings combined with systemic antibiotherapy. Application of vacuum assisted closure (VAC) facilitates the evacuation of pathological discharge, reduces tissue oedema and eliminates bacterial biofilm. Complementary administration of antibiotics to control chronic infection relies today in most cases on vancomycin, ciprofloxacin or piperacillin with tazobactam, with good clinical effect.An alternative to antibiotics against MRSA, administered at hospitals might be dalbavancin, a new generation lipoglycopeptide, which belongs to the same class as vancomycin. Introduction of dalbavancin and VAC might be an alternative to traditional methods of therapy.

BACKGROUND: Surgical treatment of recurrent anal fistulas can lead to numerous complications, including fecal incontinence. Therefore, sphincter preserving techniques are gaining more popularity. OBJECTIVE: The aim of the study was to assess effectiveness of platelet-rich plasma (PRP) therapy in the patients with recurrent cryptoglandular anal fistulas. METHODS: A cohort of 18 patients with anal fistulas was enrolled into a preliminary and prospective trial. They were divided into two groups consisting of eight and ten patients respectively. PRP was injected locally in all patients, however in the group II it was applied after 7 days drainage of fistulas with polyurethane foam or negative pressure wound therapy. On average, three doses of PRP were administered, but with the opportunity to double the number of applications if it was clinically justified. The patients were evaluated in an out-patient department after fortnight and then in 1, 6, and 12 months following the last PRP application. RESULTS: Anal fistulas were closed in 4 (50%) patients from the group I and in 7 (70%) patients form the group II. Although, the difference between both groups was not statistically significant, PRP therapy should be preceded with fistulous tract drainage in all patients. Summarizing, that successful result was achieved in 11 (60%) patients from the entire group of 18 participants. CONCLUSION: The rate of recurrent cryptoglandular anal fistulas closure reaching 60%, after topical treatment with PRP, exceeds the results of other sphincter-saving methods of treatment. Therefore, it might become a novel method of anal fistulas therapy.

We conclude that NAG induced changes in the skin fibroblasts' properties maybe important for prevention of the age-dependent changes in its structure and function.

Aim Minimally invasive procedures for the treatment of anal fistulas are gaining more and more popularity. For this purpose, Platelet-Rich Plasma (PRP) are administered to accelerate the healing process of various difficult wounds or lesions. The aim of this study was to evaluate preliminary results of PRP injection into the tissues adjacent to anal fistulas. Patients and methods A cohort of 42 patients with recurrent anal fistula, who underwent at least one cutting procedure previously, were enrolled into this preliminary and prospective trial. Closure of internal orifice was performed in all investigated patients, however, in 22 patients from group I, that procedure was combined with topical injection of PRP. In the postoperative period, the PRP administration could be repeated in case of incomplete fistula closure. Follow-up consisted of out-patient visits in a fortnight, 1, 2, and 12 months. Results Complete closure of anal fistulas was achieved in 16 (75%) patients from group I and 10 (45,5%) patients from group II. The fistulas were healed in 9 patients from group I after single application of PRP. In the next 9 patients with incomplete fistula closure, the injection was repeated 2 to 4 times every fortnight leading finally to complete recovery in 6 of them. Conclusions Surgical fistula closure with local PRP application spares the anal sphincter and gives the opportunity to repeat the procedure several times if necessary. Treatment of recurrent anal fistulas with PRP can be considered as last resort therapy.

Treatment of gastrointestinal fistulas after staple line leaks is difficult and non-invasive procedures such as endoclips, stents or endoscopic vacuum assisted closure (E-VAC) are sometimes not adequate. Fibrin sealants (FS) may promote healing, although today are used mainly to prevent anastomosis dehiscence within digestive tract. The authors present a 37-year-old female patient who developed a chronic gastrocutaneous fistula after sleeve gastrectomy for severe obesity treated successfully with a combination of E-VAC and a fibrin sealant. Long term peritoneal drainage, total parenteral nutrition, and antibiotic therapy for the next six weeks failed to close the leakage. Ultimately the fistula was closed after 6 changes of E-VAC and final implementation of a fibrin sealant. The duration of treatment was 81 days, including 34 days of E-VAC treatment and FS application. Complete closure of the fistula was visualized on gastroscopy six weeks after the treatment.

Introduction: Most postoperative rectal leakages can be successfully treated with minimally invasive procedures. Endoscopic vacuum therapy supported by tissue adhesives or cellular growth stimulants closes even chronic anastomotic fistulas.Aim: To present a treatment strategy for postoperative leakage of rectal anastomoses with noninvasive procedures. Material and methods: From 2015 to 2020, a group of 25 patients with postoperative rectal leakage was enrolled for minimally invasive treatment. The indication for the therapy was anastomotic dehiscence not exceeding 1/2 of the bowel circuit and the absence of severe septic complications. All patients were healed with endoluminal vacuum therapy (EVT) supported by hemostatic clips, tissue adhesives or cellular growth stimulants. Results: Complete drainage and reduction of leakage were achieved in 23 patients. The fistula was totally closed in 21 patients and in 2 of them it was restricted to a slit sinus. Two patients required revision surgery. Endoscopic treatment attempted within 7 days from leakage detection, as well as the size of the dehiscence less than 1/4 of the bowel circuit, increased the chance of full healing. In contrast, ultra low resection and neoadjuvant radiotherapy impaired the healing process, limiting the effectiveness of noninvasive therapy. Conclusions: The minimally invasive approach successfully restricts anastomotic leakage and reduces the diameter of dehiscence. Early initiation of the therapy and the size of rupture determine the final results. The use of complementary endoscopic solutions, such as clips or tissue adhesives, increases the effectiveness of the noninvasive strategy.