Method for Management of Perianal Fistula with New Device: Progressive Curettage of the Tract and Sealing with Platelet-Rich Fibrin

Abstract

Surgical treatment of high perianal fistulas, which affect a significant proportion of the sphincter apparatus, is difficult and associated with considerable risk of impaired anal continence. The diversity of approaches proposed for the treatment of complex perianal fistulas reflects the fact that no method has yet been shown to be fully satisfactory. We believe the successful treatment of this condition is directly proportional to the amount of fibrous tissue that can be removed. We used a kit of small curettes, of different thicknesses and sizes, incorporating spicules that enable the physician to remove fibrous tissue from the fistula tract. The small size and varying thicknesses of the curettes enable them to mold to the curves of the fistula tract and to remove tissue by de-roofing from the shallowest to the deepest layers, thus excising the entire fibrous tract. The tract is then sealed using autologous fibrin, applied through a catheter, with the help of a monitor indicating the amount of product remaining at all times. Finally, the internal orifice is closed by simple suturing.

3D-Printed Surgical Steel Curettes for the Treatment of Perianal Fistula

“…The use of this curette design complements the normal surgical fistula sealing technique by debriding the fistula tract to remove all the granulation tissue in its path, 6 thereby facilitating the presence of healthy tissue and enhancing blood flow, as reported by Buchanan et al, in a study of experimental models in pigs, 7 and by van Koperen et al 8…”

“…The use of this curette design complements the normal surgical fistula sealing technique by debriding the fistula tract to remove all the granulation tissue in its path, 6 thereby facilitating the presence of healthy tissue and enhancing blood flow, as reported by Buchanan et al, in a study of experimental models in pigs, 7 and by van Koperen et al 8 A limitation of the curettes currently used for debriding perianal fistulas is that they are unable to adapt to the curvature of the tract. Accordingly, it is impossible to resect the entire path, and these curettes are only used as an auxiliary treatment (the tract is resected to the extent possible with the instrument, after which the appropriate surgical technique is applied).…”

“…With this aim in mind, we have designed a curette 5,6 that is small enough to be drawn along the entire length of the fistula. The curette has a hole at each end through which the sutures passed through the fistula tract can be tied.…”