Management of idiopathic anal fistula using cross‐linked collagen: a prospective phase 1 study

Abstract

In the short-to-medium term, both techniques are safe and equally effective. The results justify continued research into the use of biomaterials to heal anal fistulae.

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

“…The collagen fistula plug has a rigid structure that may lead to a poor fit and extrusion as well as interfering with the healing process by leaving unrecognized secondary tracts untreated. Surgisis ® biomaterial (Cook Biotech) is noncross‐linked, possibly leading to bacterial enzymatic degradation in complex environments . In contrast, Permacol™ paste is cross‐linked and more readily resists enzymatic degradation while facilitating fibroblast and vascular ingrowth .…”

The treatment of anal fistula: secondACPGBIPosition Statement – 2018

“…Some authors have reported better healing rates in longer tracks, suggesting that shorter tracks (< 3.5 cm) are less likely to retain the glue [155,158], but this has been contradicted in other reports [159][160][161]. Technical errors have been suggested for failure, including inadequate curettage and washout to remove all infected and epithelialized tissue [155,161,162], or incomplete filling of the track with the glue to ensure occlusion [155].…”

Novel biological strategies in the management of anal fistula

“…The only consistency is that to date no study matches fistulotomy (whether by one or two stages, or seton induced) with regard to long-term fistula eradication rates. The success of fistulotomy is due to its conversion of a chronic enclosed to an acute open wound, thereby allowing the healing cascade to recommence with the potential for progression to complete tissue repair [13]. To achieve similar results without sphincter division, fistula tracts need to be cleared of all granulation tissue or epithelial lining (in order to allow sufficient fibroblast and endothelial cell migration), and the internal opening needs to be appropriately closed.…”