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Erschienen in: Techniques in Coloproctology 3/2017

16.02.2017 | Original Article

Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up

verfasst von: B. Fabiani, C. Menconi, J. Martellucci, I. Giani, G. Toniolo, G. Naldini

Erschienen in: Techniques in Coloproctology | Ausgabe 3/2017

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Abstract

Background

Optimal surgical treatment for anal fistula should result in healing of the fistula track and preserve anal continence. The aim of this study was to evaluate Permacol™ collagen paste (Covidien plc, Gosport, Hampshire, UK) injection for the treatment of complex anal fistulas, reporting feasibility, safety, outcome and functional results.

Methods

Between May 2013 and December 2014, 21 consecutive patients underwent Permacol paste injection for complex anal fistula at our institutions. All patients underwent fistulectomy and seton placement 6–8 weeks before Permacol™ paste injection. Follow-up duration was 12 months.

Results

Eighteen patients (85.7%) had a high transsphincteric anal fistula, and three female patients (14.3%) had an anterior transsphincteric fistula. Fistulas were recurrent in three patients (14.3%). Seven patients (33%) had a fistula with multiple tracts. After a follow-up of 12 months, ten patients were considered healed (overall success rate 47.6%). The mean preoperative FISI score was 0.33 ± 0.57 and 0.61 ± 1.02 after 12 months.

Conclusions

Permacol™ paste injection was safe and effective in some patients with complex anal fistula without compromising continence.
Literatur
1.
Zurück zum Zitat Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Abcarian H (1999) Repair of fistulas-in-ano using autologous fibrin tissue adhesive. Dis Colon Rectum 42(5):607–613CrossRefPubMed Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Abcarian H (1999) Repair of fistulas-in-ano using autologous fibrin tissue adhesive. Dis Colon Rectum 42(5):607–613CrossRefPubMed
2.
Zurück zum Zitat Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Sone JH, Song R, Abcarian H (2000) Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up (64%). Dis Colon Rectum 43(7):944–949 discussion 949-50 CrossRefPubMed Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Sone JH, Song R, Abcarian H (2000) Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up (64%). Dis Colon Rectum 43(7):944–949 discussion 949-50 CrossRefPubMed
3.
4.
Zurück zum Zitat Gisbertz SS, Sosef MN, Festen S, Gerhards MF (2005) Treatment of fistulas in ano with fibrin glue. Dig Surg 22(1–2):91–94 Epub 2005 Apr 20 CrossRefPubMed Gisbertz SS, Sosef MN, Festen S, Gerhards MF (2005) Treatment of fistulas in ano with fibrin glue. Dig Surg 22(1–2):91–94 Epub 2005 Apr 20 CrossRefPubMed
5.
Zurück zum Zitat Singer M, Cintron J, Nelson R, Orsay C, Bastawrous A, Pearl R, Sone J, Abcarian H (2005) Treatment of fistulas-in-ano with fibrin sealant in combination with intra-adhesive antibiotics and/or surgical closure of the internal fistula opening. Dis Colon Rectum 48(4):799–808CrossRefPubMed Singer M, Cintron J, Nelson R, Orsay C, Bastawrous A, Pearl R, Sone J, Abcarian H (2005) Treatment of fistulas-in-ano with fibrin sealant in combination with intra-adhesive antibiotics and/or surgical closure of the internal fistula opening. Dis Colon Rectum 48(4):799–808CrossRefPubMed
6.
Zurück zum Zitat Dietz DW (2006) Role of fibrin glue in the management of simple and complex fistula in ano. J Gastrointest Surg 10(5):631–632PubMed Dietz DW (2006) Role of fibrin glue in the management of simple and complex fistula in ano. J Gastrointest Surg 10(5):631–632PubMed
7.
Zurück zum Zitat Johnson EK, Gaw JU, Armstrong DN (2006) Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum 49(3):371–376CrossRefPubMed Johnson EK, Gaw JU, Armstrong DN (2006) Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum 49(3):371–376CrossRefPubMed
8.
Zurück zum Zitat Ellis CN (2007) Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ 64(1):36–40CrossRefPubMed Ellis CN (2007) Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ 64(1):36–40CrossRefPubMed
9.
Zurück zum Zitat Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD (2009) Anal fistula plug: initial experience and outcomes. Dis Colon Rectum 52(2):248–252CrossRefPubMed Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD (2009) Anal fistula plug: initial experience and outcomes. Dis Colon Rectum 52(2):248–252CrossRefPubMed
10.
Zurück zum Zitat El-Gazzaz G, Zutshi M, Hull T (2010) A retrospective review of chronic anal fistulae treated by anal fistulae plug. Colorectal Dis 12(5):442–447CrossRefPubMed El-Gazzaz G, Zutshi M, Hull T (2010) A retrospective review of chronic anal fistulae treated by anal fistulae plug. Colorectal Dis 12(5):442–447CrossRefPubMed
11.
Zurück zum Zitat van Koperen PJ, Bemelman WA, Gerhards MF, Janssen LW, van Tets WF, van Dalsen AD, Slors JF (2011) The anal fistula plug treatment compared with the mucosal advancement flap for cryptoglandular high transsphincteric perianal fistula: a double-blinded multicenter randomized trial. Dis Colon Rectum 54(4):387–393CrossRefPubMed van Koperen PJ, Bemelman WA, Gerhards MF, Janssen LW, van Tets WF, van Dalsen AD, Slors JF (2011) The anal fistula plug treatment compared with the mucosal advancement flap for cryptoglandular high transsphincteric perianal fistula: a double-blinded multicenter randomized trial. Dis Colon Rectum 54(4):387–393CrossRefPubMed
12.
Zurück zum Zitat Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J, De-La-Quintana P, Garcia-Arranz M, Pascual M (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52(1):79–86CrossRefPubMed Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J, De-La-Quintana P, Garcia-Arranz M, Pascual M (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52(1):79–86CrossRefPubMed
13.
Zurück zum Zitat Herreros MD, Garcia-Arranz M, Guadalajara H, De-La-Quintana P, Garcia-Olmo D, FATT Collaborative Group (2012) Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula Advanced Therapy Trial 1) and long-term evaluation. Dis Colon Rectum 55(7):762–772CrossRefPubMed Herreros MD, Garcia-Arranz M, Guadalajara H, De-La-Quintana P, Garcia-Olmo D, FATT Collaborative Group (2012) Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula Advanced Therapy Trial 1) and long-term evaluation. Dis Colon Rectum 55(7):762–772CrossRefPubMed
14.
Zurück zum Zitat Himpson RC, Cohen CR, Sibbons P, Phillips RK (2009) An experimentally successful new sphincter-conserving treatment for anal fistula. Dis Colon Rectum 52(4):602–608CrossRefPubMed Himpson RC, Cohen CR, Sibbons P, Phillips RK (2009) An experimentally successful new sphincter-conserving treatment for anal fistula. Dis Colon Rectum 52(4):602–608CrossRefPubMed
15.
Zurück zum Zitat Milito G, Cadeddu F (2009) Conservative treatment for anal fistula: collagen matrix injection. J Am Coll Surg 209(4):542–543 author reply 543 CrossRefPubMed Milito G, Cadeddu F (2009) Conservative treatment for anal fistula: collagen matrix injection. J Am Coll Surg 209(4):542–543 author reply 543 CrossRefPubMed
16.
Zurück zum Zitat Sileri P, Boehm G, Franceschilli L, Giorgi F, Perrone F, Stolfi C, Monteleone G, Gaspari AL (2012) Collagen matrix injection combined with flap repair for complex anal fistula. Colorectal Dis 14(Suppl 3):24–28CrossRefPubMed Sileri P, Boehm G, Franceschilli L, Giorgi F, Perrone F, Stolfi C, Monteleone G, Gaspari AL (2012) Collagen matrix injection combined with flap repair for complex anal fistula. Colorectal Dis 14(Suppl 3):24–28CrossRefPubMed
17.
Zurück zum Zitat Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G (2005) Practice parameters for the treatment of perianal abscess and fistula in ano. Dis Colon Rectum 48:1337–1342CrossRefPubMed Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G (2005) Practice parameters for the treatment of perianal abscess and fistula in ano. Dis Colon Rectum 48:1337–1342CrossRefPubMed
18.
Zurück zum Zitat Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42(12):1525–1532CrossRefPubMed Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42(12):1525–1532CrossRefPubMed
19.
Zurück zum Zitat Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery: factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729CrossRefPubMed Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery: factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729CrossRefPubMed
20.
Zurück zum Zitat van Koperen PJ, Wind J, Bemelman WA, Babkx R, Reitsma JB, Slors JF (2008) Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon Rectum 51:1475–1481CrossRefPubMed van Koperen PJ, Wind J, Bemelman WA, Babkx R, Reitsma JB, Slors JF (2008) Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon Rectum 51:1475–1481CrossRefPubMed
21.
Zurück zum Zitat Westerterp M, Volkers NA, Poolman RW, van Tets WF (2003) Anal fistulotomy between Skylla and Charybdis. Colorectal Dis 5:549–551CrossRefPubMed Westerterp M, Volkers NA, Poolman RW, van Tets WF (2003) Anal fistulotomy between Skylla and Charybdis. Colorectal Dis 5:549–551CrossRefPubMed
22.
Zurück zum Zitat Tozer P, Sala S, Cianci V, Kalmar K, Atkin GK, Rahbour G, Ranchod P, Hart A, Phillips RK (2013) Fistulotomy in the tertiary setting can achieve high rates of fistula cure with an acceptable risk of deterioration in continence. J Gastrointest Surg. 17(11):1960–1965CrossRefPubMed Tozer P, Sala S, Cianci V, Kalmar K, Atkin GK, Rahbour G, Ranchod P, Hart A, Phillips RK (2013) Fistulotomy in the tertiary setting can achieve high rates of fistula cure with an acceptable risk of deterioration in continence. J Gastrointest Surg. 17(11):1960–1965CrossRefPubMed
23.
Zurück zum Zitat Ritchie RD, Sackier JM, Hodde JP (2009) Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 11(6):564–571CrossRefPubMed Ritchie RD, Sackier JM, Hodde JP (2009) Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 11(6):564–571CrossRefPubMed
24.
Zurück zum Zitat Lehmann JP, Graf W (2013) Efficacy of LIFT for recurrent anal fistula. Colorectal Dis 15:592–595CrossRefPubMed Lehmann JP, Graf W (2013) Efficacy of LIFT for recurrent anal fistula. Colorectal Dis 15:592–595CrossRefPubMed
25.
Zurück zum Zitat Chen TA, Liu KY, Yeh CY (2012) High ligation of the fistula track by lateral approach: a modified sphincter-saving technique for advanced anal fistulas. Colorectal Dis 14:e627–e630CrossRefPubMed Chen TA, Liu KY, Yeh CY (2012) High ligation of the fistula track by lateral approach: a modified sphincter-saving technique for advanced anal fistulas. Colorectal Dis 14:e627–e630CrossRefPubMed
26.
Zurück zum Zitat Dubsky PC, Stift A, Friedl J, Teleky B, Herbst F (2008) Endorectal advancement flaps in the treatment of high anal fistula of cryptoglandular origin: full-thickness vs. mucosal-rectum flaps. Dis Colon Rectum 51:852–857CrossRefPubMed Dubsky PC, Stift A, Friedl J, Teleky B, Herbst F (2008) Endorectal advancement flaps in the treatment of high anal fistula of cryptoglandular origin: full-thickness vs. mucosal-rectum flaps. Dis Colon Rectum 51:852–857CrossRefPubMed
27.
Zurück zum Zitat Koehler A, Risse-Schaaf A, Athanasiadis S (2004) Treatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study. Dis Colon Rectum 47:1874–1882CrossRefPubMed Koehler A, Risse-Schaaf A, Athanasiadis S (2004) Treatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study. Dis Colon Rectum 47:1874–1882CrossRefPubMed
28.
Zurück zum Zitat van Onkelen RS, Gosselink MP, Schouten WR (2012) Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract? Dis Colon Rectum 55:163–166CrossRefPubMed van Onkelen RS, Gosselink MP, Schouten WR (2012) Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract? Dis Colon Rectum 55:163–166CrossRefPubMed
29.
Zurück zum Zitat Gottgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO (2015) Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 30(5):583–593CrossRefPubMed Gottgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO (2015) Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 30(5):583–593CrossRefPubMed
30.
Zurück zum Zitat Jarman-Smith ML, Bodamyali T, Stevens C, Howell JA, Horrocks M, Chaudhuri JB (2004) Porcine collagen crosslinking, degradation and its capability for fibroblast adhesion and proliferation. J Mater Sci Mater Med 15(8):925–932CrossRefPubMed Jarman-Smith ML, Bodamyali T, Stevens C, Howell JA, Horrocks M, Chaudhuri JB (2004) Porcine collagen crosslinking, degradation and its capability for fibroblast adhesion and proliferation. J Mater Sci Mater Med 15(8):925–932CrossRefPubMed
31.
Zurück zum Zitat Giordano P, Sileri P, Buntzen S, Stuto A, Nunoo-Mensah J, Lenisa L, Singh B, Thorlacius-Ussing O, Griffiths B, Ziyaie D (2016) A prospective multicentre observational study of Permacol™ collagen paste for anorectal fistula: preliminary results. Colorectal Dis 18(3):286–294CrossRefPubMed Giordano P, Sileri P, Buntzen S, Stuto A, Nunoo-Mensah J, Lenisa L, Singh B, Thorlacius-Ussing O, Griffiths B, Ziyaie D (2016) A prospective multicentre observational study of Permacol™ collagen paste for anorectal fistula: preliminary results. Colorectal Dis 18(3):286–294CrossRefPubMed
32.
Zurück zum Zitat Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD (2002) A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum 45(12):1608–1615CrossRefPubMed Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD (2002) A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum 45(12):1608–1615CrossRefPubMed
33.
Zurück zum Zitat Soltani A, Kaiser AM (2010) Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum 53(4):486–495CrossRefPubMed Soltani A, Kaiser AM (2010) Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum 53(4):486–495CrossRefPubMed
Metadaten
Titel
Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up
verfasst von
B. Fabiani
C. Menconi
J. Martellucci
I. Giani
G. Toniolo
G. Naldini
Publikationsdatum
16.02.2017
Verlag
Springer International Publishing
Erschienen in
Techniques in Coloproctology / Ausgabe 3/2017
Print ISSN: 1123-6337
Elektronische ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-017-1590-3

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