A anorectal fistula treatment with acellular extracellular matrix: A new technique

Abstract

AIM:To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix (AEM). METHODS: Thirty patients with anorectal fistula were treated with AEM. All fistula tracts and primary openings were identified using conventional fistula probe. All tracts were curetted with curet and irrigated with hydrogen peroxide and metronidazole. The AEM was pulled into the fistula tract from secondary to primary opening. The material was secured at the level of the primary opening. The excess AEM was trimmed at skin level at the secondary opening. RESULTS: All of the 30 patients had successful closure of their fistula after a 7-14 d follow-up. The healing rate of anal fistula in treatment group was 100%. The ache time, healing time and anal deformation of treatment group were obviously superior to traditional surgical methods. CONCLUSION: Using AEM anal fistula plug in treatment that causes the anorectal fistula is safe and successful in 100% of patients. It can reduce pain, shorten disease course and protect anal function.

A Systematic Review of the Anal Fistula Plug for Patients With Crohn's and Non-Crohn's Related Fistula-in-Ano

“…The shortest mean or median follow-up in the 20 studies was 3 months, and the longest follow-up was 24.5 months ( [60][61][62] Unable to separate rectovaginal, anovaginal or pouch-vaginal fistulas = 3 [63][64][65][66][67][68][69][70][71] Inadequate f/up = 1 59 Patients included in later publication = 19 [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Review articles, comments, conference proceedings = 12 1 Eight of the 20 included articles reported continence levels pre-and postinsertion of the AFP. 25,79,80,84,85,89,92,94 There were no reported cases of any significant change in continence after insertion of the AFP in any of the patients in these studies (n ϭ 196 patients).…”

“…First, the follow-up from 1 study to the next is highly variable, and studies with a follow-up of 6 weeks or less probably do not give as accurate a picture of the success of the AFP as a study with a follow-up of 6 months or more. 59,80 Second, several articles contain patients with a mixture of fistula etiologies and do not clearly separate these patients in the results. For example, grouping together the results of the bioprosthetic fistula plug for patients with cryptoglandular fistulas, fistulas resulting from Crohn's disease and ileal-pouch anal or pouch-vaginal fistulas is of moderate benefit, because the results are probably different for each subgroup of patients.…”

Practice Parameters for the Management of Perianal Abscess and Fistula-in-Ano

“…Although limited data have demonstrated success with the plug in up to 70% to 100% of low-lying fistulas, outcomes in complex disease have been less promising. [72][73][74][75] In patients with Crohn's disease, initial reports demonstrated closure rates of 80%, 76 with the same group demonstrating persistent closure in 83% of all types of complex fistulas at a median of 12 months. 77 Unfortunately, most other studies have not been able to replicate those results, with the majority of studies reporting Ͻ50%.…”

Long-term Outcomes of Human Acellular Dermal Matrix Plug in Closure of Complex Anal Fistulas With a Single Tract

“…2,21 Fistula tracts were identified and the primary opening was located using a fistula probe or hydrogen peroxide instillation. Gentle mechanical debridement was performed with a blunt curette, making sure not to enlarge the track, followed by irrigation with hydrogen peroxide and sterile isotonic saline.…”