A New, Conservative Treatment for Perianal Fistula that May Halve the Need for Surgical Intervention: Case Series

Abstract

Purpose. In the last two decades, many sphincter preservation techniques have been proposed for the treatment of anal fistula. Since 2011, our surgical team has treated fistulas by sealing them with platelet-rich fibrin (PRF). This is performed actually as an outpatient process, without anaesthesia. Methods. Patients were treated with PRF sealant, during the period June 2012–March 2017. The fibrin preparation is applied in the fistulous tract, with no need for any type of anaesthesia, and so the patient can go home immediately afterwards, without further observation. Results. After an average follow-up of 26.49 months, the perianal fistula had healed completely in 52.86% of the patients (n = 37), who each received an average of 1.92 sealant operations. In another 10 cases, the sealing was initially successful, but a relapse occurred during the follow-up period. Conclusion. The outpatient treatment of perianal fistula with PRF is totally harmless, is very low cost and achieves very acceptable results. In our opinion, therefore, this could be considered an appropriate initial treatment for perianal fistula, with surgical treatment being reserved if this approach is unsuccessful, thereby avoiding many complications and producing significant economic savings for the health system.

Surgical treatment of anal fistula

“…Применение фибринового клея имеет немаловажное значение для лечения свищей прямой кишки, он рекомендуется для использования в качестве дополнения к стандартным хирургическим методам в качестве как кровоостанавливающего средства, так и первого этапа в лечении свища заднего прохода. При неудаче сохраняется возможность применить этот метод повторно либо перейти к традиционному хирургическому лечению [40]. Использование фибринового клея предпочтительнее для простых анальных свищей.…”

Design of a new fistula plug using acellular small intestinal submucosa with platelet-rich fibrin for anal fistula in rabbit model

“…Its anti-in ammatory effect has been linked to the migration of the host leukocytes to the brin network. It has also been used for the management of anal stula, but the success rates were varying because of its insu cient consistency to support the soft tissue and low resistance to mechanical force (14,15).…”