The treatment of anal fistulas with biologically derived products: is innovation better than conventional surgical treatment? An update

Abstract

New technical approaches involving biologically derived products have been applied in the treatment for anal fistulas in order to avoid the risk of fecal incontinence. The aim of this review was to evaluate the scientific evidence present in the literature regarding these techniques. Trials comparing surgery (fistulotomy, advancement mucosal flap closure and placement of seton) versus fibrin glue, fistula plug or acellular dermal matrix were considered. In fibrin glue versus traditional surgical treatment the healing rate was higher in the surgery group, and the recurrence rate was lower in the traditional surgery group, but these results were not statistically relevant. In acellular dermal matrix (ADM) versus traditional surgical treatment the recurrence rate of fistulas was significantly lower in the ADM group, but non-significant differences were recorded in incontinence and anal deformity. Our review shows that there are no significant advantages of the new techniques involving biologically derived products. Further randomized controlled trials are needed.

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

“…Since then, FIPS has been adopted also for complex anal fistulas, in order to obtain low recurrence rates without compromising continence as the lay-open technique does. Recently, the interest in FIPS has gradually increased [21], in parallel with the realization that the initial enthusiasm for the new minimally invasive techniques cannot hold up in the face of the long-term follow-up data [1,15]. Due to the lack of clear scientific evidence, FIPS is still regarded with skepticism mainly as regards the risk of postoperative fecal incontinence [22].…”

“…Although advances in surgery and technology have led to various ''minimally invasive'' approaches [1,2], results in terms of success rate and recurrence are quite disappointing. The failure rate is approximately 30-60 % for established surgical procedures such as the endorectal advancement flap (ERAF) [3,4] and injection of biological glues [5,6].…”

S3 guidelines: cryptoglandular anal fistulas

“…Insgesamt wurden die Plug-Technik und weitere neue Verfahren in diversen Reviews aufgearbeitet [82,139,214,234,292,296,332,402]. Cirocchi et al [82] …”

Operative Verfahren bei hohen kryptoglandulären Analfisteln: Systematische Übersicht und Metaanalyse

“…In den letzten Jahren wurden aber weiter Übersichtsarbeiten veröffentlicht, die sich zumeist auf eine der verfügbaren Techniken konzentrieren [7,33,[35][36][37] …”