Minimally Invasive Treatment of Recurrent Anal Fistulas with Autologous Platelet-Rich Plasma Combined With Internal Orifice Closure

Abstract

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.

Impact of Preoperative Three-Dimensional Endoanal Ultrasound on the Surgical Outcome of Primary Fistula in Ano. A Multi-Center Observational Study of 253 Patients

“…In our series failure to identify the internal opening, as detected by 3D-EAUS, represented, according with literature, 27-33 a relevant risk factor for unsuccessful surgery whereas failure in detecting fistula primary tract and secondary extensions showed a lower prognostic value. However, as regards the primary tracts classification, the difference in the success rate between patients with concordant and discordant ultrasound and surgical findings were considerable (12%), suggesting a potential statistical significance in a larger patients sample size.…”

“…24 The diagnostic value of 3D-EAUS in patients with fistula in ano is represented by the accurate ultrasound identification and depiction of the main fistula characteristics including internal orifice, primary tract and secondary extensions. 25,26 In our series failure to identify the internal opening, as detected by 3D-EAUS, represented, according with literature, [27][28][29][30][31][32][33] a relevant risk factor for unsuccessful surgery whereas failure in detecting fistula primary tract and secondary extensions showed a lower prognostic value. However, as regards the primary tracts classification, the difference in the success rate between patients with concordant and discordant ultrasound and surgical findings were considerable (12%), suggesting a potential statistical significance in a larger patients sample size.…”