Assessment of Recurrent Anal Fistulas Treatment With Platelet-Rich Plasma

Abstract

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.

Dehiscence of colorectal anastomosis treated with noninvasive procedures

“…EVT is not only a kind of continuous drainage but it also reduces inflammatory edema, increases blood flow, shrinks the defect, and finally it accelerates formation of fresh granulation tissue with subsequent closure of the dehiscence. Stents used in other gastrointestinal leaks are of less use in these cases [ 28 , 29 ].…”

“…The local supply of PRP reflects the natural healing process and leads to the production of granulation tissue and a network of blood vessels. The authors’ experience in the healing of leaks by endoscopic application of autogenous PRP and platelet rich fibrin (PRF) is optimistic, the more so as the method produced satisfactory results in the treatment of recurrent anal fistulas [ 29 , 33 ].…”

Autologous Bioactive Compound Concentrated Growth Factor Ameliorates Fistula Healing of Anal Fistula in a Pig Model and Promotes Proliferation and Migration of Human Skin Fibroblasts via Regulating the MEK/ERK Pathway

“…In addition, PRP has been widely used in clinical practice in recent years due to its simple preparation, high safety, and autologous origin, thus eliminating the rejection between tissues [ 6 , 7 ]. Moreover, clinical trials have reported that PRP-filled fistula treatment is safe and has a certain cure rate [ 8 , 9 ]. However, PRP is close to fluid in shape and is difficult to retain in the fistula for sufficient time to affect its role as a biological skeleton.…”