Autologous Platelet-Rich Fibrin in the Management of Recurrent Complex Fistula in Ano

Recurrence of disease after surgery for fistula occurs in approximately 30%–40% of patients. Treatment of a recurrent fistula has an increased risk of failure and further recurrence. The aim of this study was to find out the effectiveness of video-assisted anal fistula treatment (VAAFT) in the treatment of recurrent fistula and also to compare the effect of the two adjuvants, fibrin and platelet-rich fibrin (PRF), in reducing recurrence in a recurrent fistula. A retrospective observational study was done on a cohort of patients with fistula-in-ano being treated at our center between 2015 and 2021. Of 85 patients that underwent VAAFT, 36 had recurrent disease and were allotted to two groups, one group receiving fibrin and the other PRF. Details of patients were collected from the hospital database and by telephonic interview. To test the statistical significance of the difference in the proportion of categorical variables between two groups, chi-square test was used and Mann–Whitney U test for the difference in the mean-time of healing between two groups. Recurrence rate following VAAFT in patients with recurrent fistula-in-ano in our series was found to be 25%. A significant reduction in recurrence was noted in patients who received PRF as adjunct when compared to patients who received fibrin glue as adjunct (P = 0.0023). VAAFT is an excellent cost-effective choice for the management of recurrent fistula-in-ano. Use of PRF along with VAAFT improves the outcome of the procedure.

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Effectiveness of Video-assisted Anal Fistula Treatment (VAAFT) and Its Adjuncts in the Treatment of a Cohort of Patients with Recurrent Fistula-in-ano

Ramachandran

Gunasekharan

Kumaran

et al. 2021

Amrita Journal of Medicine

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Fibrin glue versus autologous platelet-rich fibrin - comparison of effectiveness on the cohort of patients with fistula-in-ano undergoing video-assisted anal fistula treatment

Ramachandran

Gunasekharan

Pillai

et al. 2022

Journal of Minimal Access Surgery

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Context: Minimally invasive sphincter preserving procedures like ligation of intersphincteric fistula tract (LIFT) and video-assisted anal fistula treatment (VAAFT) are being increasingly used in the treatment of fistula-in-ano. The addition of adjuncts like fibrin glue has improved the results for VAAFT. Our unit has used platelet-rich fibrin (PRF) as an innovative adjunct for VAAFT. Aims: To compare the effectiveness of two different adjuncts, fibrin glue and autologous PRF, used to fill the treated fistula tracts following VAAFT. Settings and Design: Retrospective observational study on a cohort of patients undergoing VAAFT at a tertiary centre between 2015 and 2020 comparing two adjuncts used with VAAFT procedure. Subjects and Methods: Data of patients who underwent VAAFT for fistula-in-ano were obtained from the hospital database. Group A included patients treated with fibrin as adjunct and PRF as adjunct in Group B. Patients were followed up at 1, 3 and 6 months post-operatively and by a telephonic interview in 2020 to ascertain recent status. All data were entered into an excel sheet. Statistical Analysis Used: Data were analysed using SPSS V20 to test the statistical significance of the difference in the mean healing time between two groups, Mann–Whitney U-test was used and for age, Student's t-test was used. Results: There were 41 patients in Group A and 24 in Group B. There was a significant reduction in recurrence rate in Group B (P = 0.032) and in those patients who had a single internal opening (P = 0.045), single external opening (P = 0.03) and complex tracts (P = 0.033). PRF was cheaper than Fibrin glue. Conclusions: PRF is more effective and economical with lower recurrence rates.

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Autologous Platelet-Rich Fibrin in the Management of Recurrent Complex Fistula in Ano

Cited by 2 publications

References 8 publications

Effectiveness of Video-assisted Anal Fistula Treatment (VAAFT) and Its Adjuncts in the Treatment of a Cohort of Patients with Recurrent Fistula-in-ano

Effectiveness of Video-assisted Anal Fistula Treatment (VAAFT) and Its Adjuncts in the Treatment of a Cohort of Patients with Recurrent Fistula-in-ano

Fibrin glue versus autologous platelet-rich fibrin - comparison of effectiveness on the cohort of patients with fistula-in-ano undergoing video-assisted anal fistula treatment

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