Final results of a European, multicentre, prospective, observational study of Permacol™ collagen paste injection for the treatment of anal fistula

Giordano, Pasquale; Sileri, Pierpaolo; Buntzen, Steen; Stuto, Angelo; Nunoo‐Mensah, Joseph W.; Lenisa, Leonardo; Singh, Baljit; Thorlacius-Ussing, Ole; Griffiths, Ben; Ziyaie, Dorin

doi:10.1111/codi.13715

Cited by 19 publications

(30 citation statements)

References 20 publications

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“…Our overall healing rate was disappointing compared with the results of similar studies, which reported healing rates ranging from 47.6% to 82.3%. 14,[32][33][34] This difference might be explained by the heterogeneous populations selected in these studies, making it impossible to compare their clinical outcomes with our results. Other possible explanations for the discrepancy in the reported success rates might be related to differences in the technique of closure of the internal opening of the fistula.…”

Section: Discussionmentioning

confidence: 81%

“…31 When placed into the fistula tract, the Permacol paste occludes the tract without requiring sphincter division, thus eliminating the risk of subsequent incontinence. 14,[32][33][34] Implantation of the paste is a technically simple procedure that requires only a minimal amount of operating room time.…”

Section: Discussionmentioning

confidence: 99%

“…Other possible explanations for the discrepancy in the reported success rates might be related to differences in the technique of closure of the internal opening of the fistula. 14,[32][33][34] An adequate follow-up duration is essential for assessment of the cure rate. In our series, 4 (9%) patients developed late recurrence after 1 year of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the relatively long duration of follow-up in our study might explain the difference between our results and those of studies with a shorter follow-up duration. 14,[32][33][34] We hypothesized that there are several reasons for treatment failure, including the role of a loose seton. First, poor treatment results could be a result of inadequate removal of granulation tissue from the internal wall of the fistula tract, which inhibits fibroblast infiltration, vascular ingrowth, and tissue remodeling.…”

Section: Discussionmentioning

confidence: 99%

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Permacol Collagen Paste Injection for Treatment of Complex Cryptoglandular Anal Fistulas: An Observational Cohort Study With a 2-Year Follow-up

et al. 2018

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Background. Permacol paste injection is a novel treatment approach for complex cryptoglandular anal fistulas. This study was performed to evaluate the long-term clinical outcomes of treatment with Permacol paste for complex cryptoglandular fistulas. Methods. Patients with primary or recurrent complex cryptoglandular anal fistulas treated with Permacol paste from 2014 to 2016 were retrospectively analyzed. Results. A total of 46 patients (median age, 41.3 years; 21 female) underwent Permacol paste injection; 20 patients (43%) had previously undergone failed fistula surgery. The patients had experienced anal fistula-related symptoms for a median of 10 weeks (range, 3-50 weeks). All patients had a draining seton in situ for a median of 10 weeks (range, 4-46 weeks). The median follow-up time was 24 months (range, 1-25 months). At the 1-month follow-up, 2 patients had paste extrusion and 2 had anal abscesses. The mean preoperative Continence Grading Scale score was 1.10 ± 1.40, and that at 3 months postoperatively was 1.13 ± 1.39 (P = .322). There was a significant difference in the preoperative and the 1-and 3-month postoperative pain scores (P < .001). At the 24-month follow-up, the healing rate was 50% (n = 23). A total of 19 patients (41%) with a recurrent fistula after failed Permacol paste injection required additional operative procedures. The satisfaction rate at the 2-year follow-up was 65%. Conclusion. Permacol paste injection is minimally invasive and technically easy to perform. It can be considered as a viable and reasonable option for the treatment of complex cryptoglandular anal fistulas in patients with fecal continence disorders.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Permacol Collagen Paste Injection for Treatment of Complex Cryptoglandular Anal Fistulas: An Observational Cohort Study With a 2-Year Follow-up

et al. 2018

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“…Evidence so far suggests that biomedical products manufactured using animal-derived collagens do not present any significant danger to the human recipients [46]. However, some concerns still exist about the potential negative impacts of non-collagenous molecules that co-purify with animal-derived collagen.…”

Section: Potential Limitations Of Collagens Isolated From the Naturalmentioning

confidence: 99%

Three Decades of Research on Recombinant Collagens: Reinventing the Wheel or Developing New Biomedical Products?

Fertala

2020

Bioengineering

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Collagens provide the building blocks for diverse tissues and organs. Furthermore, these proteins act as signaling molecules that control cell behavior during organ development, growth, and repair. Their long half-life, mechanical strength, ability to assemble into fibrils and networks, biocompatibility, and abundance from readily available discarded animal tissues make collagens an attractive material in biomedicine, drug and food industries, and cosmetic products. About three decades ago, pioneering experiments led to recombinant human collagens’ expression, thereby initiating studies on the potential use of these proteins as substitutes for the animal-derived collagens. Since then, scientists have utilized various systems to produce native-like recombinant collagens and their fragments. They also tested these collagens as materials to repair tissues, deliver drugs, and serve as therapeutics. Although many tests demonstrated that recombinant collagens perform as well as their native counterparts, the recombinant collagen technology has not yet been adopted by the biomedical, pharmaceutical, or food industry. This paper highlights recent technologies to produce and utilize recombinant collagens, and it contemplates their prospects and limitations.

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Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

Teymouri,

Keshvari,

Ashjaei

et al. 2023

Health Science Reports

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Background and Aims: Anal fistula (AF) with cryptoglandular origin tends to recur, and multiple risk factors are implicated. Recently, some magnetic resonance imaging (MRI) findings with predictive value for disease outcomes have been proposed. These intrinsic anatomic features include those of the AF and its surrounding structures. This study aims to clarify the prognostic role of MRI in AF.Methods: We performed a systematic search of PubMed, Embase, and EBSCO databases. Two independent reviewers conducted the search and screened the articles. We selected studies that used MRI to assess AF and reported its relationship to disease outcome. We extracted data regarding the study design, type of intervention, outcome, MRI-measured items, and their significance.Results: Out of 1230 retrieved articles, 18 were eligible for final inclusion, and a total of 4026 patients were enrolled in the selected studies. For preoperative MRI, the significant items affecting the outcome were the length of the fistula, horseshoe type, presence of multiple tracts, supralevator extension, and apparent diffusion coefficient (ADC) value. Other studies investigated the healing process using postoperative MRI. Conclusion:This review found that MRI can be useful in the management of AF, both preoperatively and postoperatively. Factors, such as fistula length, horseshoe type, presence of multiple tracts, supralevator extension, and ADC value were found to be significantly associated with treatment outcomes. The presence of the fistula tract and the development of new abscesses on postoperative MRI was found to hinder the healing process. Further studies are needed to confirm these findings.

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Final results of a European, multicentre, prospective, observational study of Permacol™ collagen paste injection for the treatment of anal fistula

Abstract: Permacol paste provides a promising sphincter-preserving treatment for anal fistulas with minimal adverse side-effects. This article is protected by copyright. All rights reserved.

Cited by 19 publications

References 20 publications

Permacol Collagen Paste Injection for Treatment of Complex Cryptoglandular Anal Fistulas: An Observational Cohort Study With a 2-Year Follow-up

Permacol Collagen Paste Injection for Treatment of Complex Cryptoglandular Anal Fistulas: An Observational Cohort Study With a 2-Year Follow-up

Three Decades of Research on Recombinant Collagens: Reinventing the Wheel or Developing New Biomedical Products?

Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

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