Efficacy of Permacol injection for perianal fistulas in a tertiary referral population: poor outcome in patients with complex fistulas

Abstract

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The Efficacy of Porcine Dermal Collagen to Treat Complex Anal Fistulae. Results of a Multicenter Cohort

“…A recent meta-analysis found that the use of an empirical antibiotic treatment regimen reduced fistula formation after drainage of a perianal abscess from 24 to 16%; however, the evidence is limited and does not define the duration or type of antibiotic indicated. 24 The data are conclusive regarding the use of preceding seton, both in our series and in the two most relevant series in terms of sample size 11,21 : its use prior to definitive surgical treatment has no effect on the fistula outcome. Short fistulous tracts have been shown to have superior results in some studies, presumably because they are less complex fistulae.…”

“…16 Their good results were validated in a second experiment with 100% healing using collagen matrix alone or in combination with another maneuver (flap or fibroblast infiltration). 17 The few studies published so far indicate cure rates ranging from 20% to 77.4%, 11,12,[18][19][20][21][22][23] with significant differences depending on the number of complex patients and the length of the follow-up period. The two publications, both single-center, with the most disparate results had differences in relation to the technique of closure of the internal orifice and the proportion of complex fistulae, which, in the case of the series of Vollebregt et al, 11 included 20% of cases with double fistulous tracts and a failure rate of 80% compared to 77.4% success in the series of Bayrak et al 12 of noncomplex fistulae.…”

“…and antibiotic prophylaxis had no effect on our findings, and published research has reached similar conclusions. 11,12,[18][19][20][21][22][23] Antibiotics are used in anal fistula surgery for both preventive and therapeutic purposes, and their use varies widely. A recent meta-analysis found that the use of an empirical antibiotic treatment regimen reduced fistula formation after drainage of a perianal abscess from 24 to 16%; however, the evidence is limited and does not define the duration or type of antibiotic indicated.…”

“…10 Porcine dermal collagen (Permacol Collagen Paste [PCP]-Covidien plc, Gosport, Hampshire, UK) is another new generation biomaterial with few published studies, yet a wide range of healing results, ranging from 20 to 77%. 11,12 It is a cross-linked, acellular, and sterile porcine dermal collagen matrix (with type I and III fibers) that acts as a scaffold for the healing of the fistulous tract by inducing angiogenic activity through the release of VGEFT by local cells. 13 The aim of this study was to provide a repeatable experience with PCP in a multicenter trial and assess its effectiveness.…”

Minimally Invasive Treatment of Recurrent Anal Fistulas with Autologous Platelet-Rich Plasma Combined With Internal Orifice Closure

“…40 For comparison, the price of collagen paste is about $ 600, and the ready-made stem cell concentrate even $ 60,000, excluding VAT and additional procedure costs. 41,42…”