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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

doi: 10.1097/DCR.0000000000000023
Original Contributions: Anorectal Disease

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.

1Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

2Department of Surgery and Colorectal Surgery, Refaja Hospital, Stadskanaal, The Netherlands

3Department of Surgery and Colorectal Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands

Funding/Support: The GPS-III platelet preparation system was sponsored by Biomed Biologicals (Warsaw, IN) during this study.

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Kevin W. Göttgens, M.D., Post Box 5800, 6202 AZ, Maastricht, The Netherlands. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons