Collagen matrix injection combined with flap repair for complex anal fistula

Sileri, Pierpaolo; Boehm, Gabriele; Franceschilli, Luana; Giorgi, Federica; Perrone, Federico; Stolfi, Carmine; Monteleone, Giovanni; Gaspari, Achille

doi:10.1111/codi.12046

Cited by 19 publications

(20 citation statements)

References 19 publications

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“…The use of collagen plugs, fibrin glues and more invasive procedures such as mucosal flap advancement techniques and ligation of intersphincteric fistula tract all aim to avoid muscular injury. [9][10][11] However, success rates in terms of recurrence or postoperative incontinence have been variable. 12 First described by Meinero in 2011, 13 videoassisted anal fistula treatment (VAAFT) is an endoscopic, minimally invasive approach for the treatment of complex perianal fistulas.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted anal fistula treatment: a high volume unit initial experience

Cheung

Appleton

Rout

et al. 2018

annals

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Introduction Perianal fistulas are a common problem. Video-assisted anal fistula treatment is a new technique for the management of this difficult condition. We describe our initial experience with the technique to facilitate the treatment of established perianal fistulas. Methods We reviewed a prospectively maintained database relating to consecutive patients undergoing video-assisted anal fistula treatment in a single unit. Results Seventy-eight consecutive patients had their perianal fistulas treated with video-assistance from November 2014 to June 2016. Complete follow-up data were available in 74 patients, with median follow-up of 14 months (interquartile range 7-19 months). There were no complications and all patients were treated as day cases. Most patients had recurrent disease, with 57 (77%) having had previous fistula surgery. At follow-up, 60 (81%) patients reported themselves 'cured' (asymptomatic) including 5 patients with Crohn's disease and one who had undergone 10 previous surgical procedures. Logistical stepwise regression did not demonstrate any statistically significant factors that may have been considered to affect outcome (age, gender, diabetes, previous I&D, Crohn's disease, smoking, type of fistula). Conclusions Our data have shown that video-assisted anal fistula treatment is safe and effective in the management of perianal fistulas in our patients and this suggests it may be applied to all patients regardless of comorbidity, underlying pathology or type of fistula.

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Section: Introductionmentioning

confidence: 99%

Video-assisted anal fistula treatment: a high volume unit initial experience

Cheung

Appleton

Rout

et al. 2018

annals

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“…Permacol™ paste injection has been combined with advancement flap in seven patients with IBD‐related fistulas . Healing rates were 57% (4/7) after a median of 14 months’ follow‐up.…”

Section: Surgery For Perianal Crohn's Diseasementioning

confidence: 99%

“…The LIFT-plug technique has also been described but not reported in patients with perianal Crohn's fistulas [552]. Permacol TM paste injection has been combined with advancement flap in seven patients with IBD-related fistulas [560]. Healing rates were 57% (4/7) after a median of 14 months' follow-up.…”

Section: Hybrid Techniquesmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

et al. 2018

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Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. Results All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

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“…Several attempts have been made to help spontaneous healing using biological glues (fibrin [7], collagen paste [8]), plugs of collagen matrix [9,10] and a plethora of other methods including adipose-derived stem cells [11], but the results in the real world of surgical practice are often disappointing despite some enthusiastic (uncontrolled) reports (but we know from Feinstein that ''reports with enthusiasm have no controls and reports with controls have no enthusiasm'' [12]). In the FiLaC technique the chronically inflamed connective tissue is ''burned'' by the laser energy allowing tissue repair by the macrophages and fibroblasts coming from the surrounding healthy connective tissue [13].…”

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confidence: 99%

Anal fistula closure with FiLaC: new hope or the same old story?

Altomare

2015

Tech Coloproctol

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Throughout the centuries human beings have suffered from anal fistula.The history of medicine is full of reports about the treatment of this pathology and, in recent times, when attention has focused on preserving continence and quality of life has become a central issue in medical practice, many new sphincter-saving techniques have been proposed.Few diseases have such a wide range of severity and anatomical variations. The disease spectrum ranges from simple submucosal fistula tracts to an extrasphincteric fistulas involving multiple tracts and, while the treatment of the simplest ones is easy and safe, the more complex fistulas require expert surgeons and often multiple operations.The modern surgical approach to anal fistulas includes several sphincter-saving procedures including the closure of the fistula tract with plugs, fibrin glue, or collagen paste without fistulotomy (i.e., laying open) or by means of fistulectomy (i.e., core-out technique) [1]. However, despite several encouraging reports, though few randomized controlled trials, there is still some skepticism among coloproctologists about the effectiveness of these new sphincter-saving procedures.

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Collagen matrix injection combined with flap repair for complex anal fistula

Cited by 19 publications

References 19 publications

Video-assisted anal fistula treatment: a high volume unit initial experience

Video-assisted anal fistula treatment: a high volume unit initial experience

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

Anal fistula closure with FiLaC: new hope or the same old story?

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