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Permacol™ Collagen Paste Injection in Anal Fistula Treatment: A Retrospective Study with One-Year Follow-Up



This study aimed to evaluate the applicability, safety, results, and functional performance of Permacol™ collagen paste injection in patients with an anal fistula.


Thirty-one patients with anal fistula underwent Permacol™ collagen paste injection between February 2015 and February 2017. The patients were followed up for a total of 12 months with recovery conditions monitored at intervals of 3, 6, and 12 months. Preoperative insertion of seton was performed in 15 patients for a period of 6–8 weeks and 2 patients for a period of 12 weeks.


A trans-sphincteric anal fistula was present in 20 patients and an intersphincteric fistula was present in 11 patients. There was a recurrence in 7 patients (22.5%): 1 patient (3.2%) after 1-month follow-up, 3 patients (9.7%) after 3-month follow-up, 2 patients (6.5%) after 6-month follow-up, and 1 patient (3.2%) after 12-month follow-up. A complete recovery was observed in 24 (77.5%) patients after a 12-month follow-up. The mean Fecal Incontinence Severity Index score was 0.29 ± 0.64 preoperatively and 0.55 ± 1.03 after 12 months.


In this study, we show that treatment of patients with an anal fistula by injection of Permacol™ is a safe and successful method that does not compromise continence.

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We thank the participants of the study.


No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Mehmet Bayrak and Yasemin Altıntas have nothing to disclose.

Compliance with Ethics Guidelines

Written approval was obtained from Cukurova University Faculty of Medicine Clinical Ethical Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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All data generated or analyzed during this study are included in this article as supplementary information files.

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Correspondence to Mehmet Bayrak.

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Bayrak, M., Altıntas, Y. Permacol™ Collagen Paste Injection in Anal Fistula Treatment: A Retrospective Study with One-Year Follow-Up. Adv Ther 35, 1232–1238 (2018).

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  • Anal fistula
  • Biomaterials
  • Incontinence
  • Permacol
  • Recurrence