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Comparison of porcine collagen paste injection and rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a 2-year follow-up study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Rectal advancement flap is the standard surgical treatment for complex cryptoglandular anal fistulas, while Permacol™ collagen paste is considered an innovative treatment option for anorectal fistulas. This study aimed to compare the clinical outcomes of patients with complex cryptoglandular fistulas treated by endorectal advancement flap versus Permacol™ paste.

Methods

This study was a retrospective analysis of patients with complex cryptoglandular anal fistulas. Thirty-one patients were treated with the rectal advancement flap (RAF group), while 21 were treated with Permacol™ paste injection (PP group). In PP group, the approach consisted of loose seton positioning followed several weeks later by closure internal opening with a resorbable sutures associated with paste injection into the fistula track. Clinical outcomes were assessed in terms of healing rate, faecal continence and patient satisfaction.

Results

Seton drainage was done in all patients in both groups for a median duration of 8 weeks (range 4–18 weeks) before the final surgery (p = 0.719). No patient had faecal incontinence (CGS ≥ 5) preoperatively. Five patients (16%) in the RAF group and one (5%) in the PP group experienced faecal incontinence postoperatively. The 2-year disease-free survival was 65% in the RAF group and 52% in the PP group (p = 0.659). The median satisfaction scores were 5 (range 1–10) in the RAF group and 7 (range 2–10) in the PP group (p = 0.299).

Conclusion

The RAF appeared superior to PP in terms of fistula healing, although this result was not statistically significant. On the contrary, PP has a potential advantage in terms of continence disorders. Permacol™ paste can be considered as the initial treatment option for complex cryptoglandular anal fistulas in patients with faecal continence disorders.

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Authors and Affiliations

  1. Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, “S. Maria dei Battuti” Hospital, Via Brigata Bisagno 4, 31015, Conegliano, TV, Italy

    Michele Schiano di Visconte & Gabriele Bellio

Authors
  1. Michele Schiano di Visconte
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  2. Gabriele Bellio
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Contributions

MSdV conceived and designed the study, performed analysis and interpretation of data, and drafted the manuscript. GB performed analysis and interpretation of data, and drafted the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Michele Schiano di Visconte.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration, last amended at the 64th WMA General Assembly, Fortaleza, Brazil, October 2013, or comparable ethical standards. For this type of study, formal consent by the institutional research committee is not required in Italy.

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Schiano di Visconte, M., Bellio, G. Comparison of porcine collagen paste injection and rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a 2-year follow-up study. Int J Colorectal Dis 33, 1723–1731 (2018). https://doi.org/10.1007/s00384-018-3154-z

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