Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000023
Original Contributions: Anorectal Disease

Long-term Results of Mucosal Advancement Flap Combined With Platelet-rich Plasma for High Cryptoglandular Perianal Fistulas

Göttgens, Kevin W. M.D.1; Vening, Wouter M.D.1; van der Hagen, Stefan J. M.D., Ph.D.2; van Gemert, Wim G. M.D., Ph.D.3; Smeets, Reinier R. M.D.1; Stassen, Laurents P. M.D., Ph.D.1; Baeten, Cor G. M.D., Ph.D.1; Breukink, Stephanie O. M.D., Ph.D.1

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BACKGROUND: The long-term closure rate of high perianal fistulas after surgical treatment remains disappointing.

OBJECTIVE: The goal of this study was to improve the long-term closure rate of high cryptoglandular perianal fistulas combining mucosal advancement flap with platelet-rich plasma.

DESIGN: This study was retrospective in design.

SETTING: This study was conducted at 2 secondary and 1 tertiary referral hospitals.

PATIENTS: Patients presenting with high cryptoglandular perianal fistulas involving the middle/upper third of the anal sphincter complex were included.

INTERVENTIONS: A staged surgical treatment was performed; After seton placement, a mucosal advancement flap was combined with platelet-rich plasma.

MAIN OUTCOME MEASURES: Recurrence was the main outcome. Incontinence was the secondary outcome.

RESULTS: We operated on 25 patients between 2006 and 2012. Thirteen (52%) patients had previous fistula surgery. The median follow-up period was 27 months. One patient (4.0%) was lost to follow-up after 4 months. Freedom from recurrence at 2 years was 0.83 (95% CI, 0.62–0.93). Two of the 4 patients with a recurrence (8%) had a repeated treatment and healed. One patient (4.0%) refused another treatment, but agreed to stay in follow-up. One patient (4.0%) requested a colostomy, resulting in closure of the fistula. Complications occurred in 1 patient (4.0%). Incontinence numbers were low with a median Vaizey score of 3.0 out of a maximum of 24.

LIMITATIONS: The study was limited by its retrospective design, lack of preoperative incontinence data, selection bias, and phone interview follow-up.

CONCLUSION: The long-term outcome results of patients with primary and recurrent high cryptoglandular perianal fistulas treated with a seton followed by mucosal advancement flap and platelet-rich plasma show low recurrence, complication, and incontinence rates. Therefore, this technique seems to be a valid option as treatment. Larger and preferably randomized controlled studies are needed to further explore this surgical technique.

© 2014 The American Society of Colon and Rectal Surgeons


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