Novel Biomaterials in the Management of Anal Fistulas

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

“…Both have similar, widely variable initial success rates, which decrease with the duration of follow up [6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Proposed reasons for their failure include those associated with recurrence after conventional therapy, early extrusion of the biomaterial and those specific to their biology [23,24]. Deemed critical to the success of all traditional sphincter-sparing techniques are the elimination of acute sepsis, the eradication of secondary extensions and the adequate removal of all granulation or epithelial tissue lining the tract [25][26][27].…”

Assessment of antimicrobial microspheres as a prospective novel treatment targeted towards the repair of perianal fistulae

“…Long‐term closure rates of perianal fistulae after the use of fibrin glue have been disappointing, with success rates generally decreasing with length of follow‐up. It has been suggested that some of the biological properties of fibrin glue may contribute to the low success rates 18 . For example, although fibrin glue supports the proliferation of fibroblasts and epithelial cells, it does not allow fibroblast infiltration and may also reduce deposition of ECM proteins 18–20 .…”

“…It has been suggested that some of the biological properties of fibrin glue may contribute to the low success rates 18 . For example, although fibrin glue supports the proliferation of fibroblasts and epithelial cells, it does not allow fibroblast infiltration and may also reduce deposition of ECM proteins 18–20 . Furthermore, the fibrin glue is easily extruded through the fistula tract when subjected to high pressures, for example, during coughing or straining and a majority of it is resorbed within 5–10 days after instillation, which does not allow sufficient time for tissue regeneration required for a compensatory fibrogenic response to fill the defect 21, 22 …”

Perianal fistulae in Crohnʼs Disease: Current and future approaches to treatment

“…95 In addition, the inability of cells and extracellular matrix (ECM) proteins to infiltrate fibrin glue has been suggested to contribute to its failure to heal perianal fistulae. 102 An infection in the fistula tract may also dislodge the fibrin clot and thus result in failure. To prevent infections, antibiotics can be taken before, during, or after treatment.…”