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01.02.2015 | Original Article | Ausgabe 2/2015

Journal of Gastrointestinal Surgery 2/2015

Platelet-Rich Fibrin Sealant as a Treatment for Complex Perianal Fistulas: A Multicentre Study

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 2/2015
Autoren:
F. J. Pérez Lara, A. Moreno Serrano, J. Ulecia Moreno, J. Hernández Carmona, M. Ferrer Marquez, L. Romero Pérez, A. del Rey Moreno, H. Oliva Muñoz
Wichtige Hinweise

Author Contribution

F.J. Pérez Lara contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting the article and final approval of the version to be published. A. Moreno Serrano contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. J. Ulecia Moreno contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. J. Hernández Carmona contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. M. Ferrer Marquez contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. L. Romero Pérez contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. A. del Rey Moreno contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published. H. Oliva Muñoz contributed to the acquisition of data, revising the article critically for important intellectual content and final approval of the version to be published.

Abstract

Introduction

The incidence of perianal fistulas is high, and this condition has a profoundly negative impact on patients’ quality of life. The problem is greater when the fistula tract is high because treatment is necessarily complex (limited surgery may lead to recurrence, while aggressive surgery is associated with higher rates of faecal incontinence). To achieve a balance between these two options, we suggest that complex fistulas should be treated by sealing the tract with platelet-rich fibrin. Our objective is to evaluate the medium- to long-term results obtained from the treatment of complex perianal fistulas by sealing with platelet-rich fibrin.

Material and Methods

Prospective longitudinal multicentre study involves three colorectal surgeons working at three hospitals. The study period was October 2010 to June 2013, during which a total of 60 patients were treated for complex fistulas. In all cases, the intervention consisted of curetting the fistula tract, sealing it with platelet-rich fibrin and closing the internal orifice. We evaluated the clinical outcomes (clinical examination and pelvic magnetic resonance (MRI)) and the quality of life results, both general (SF-36) and gastrointestinal (GIQLI questionnaire) in periodic reviews during consultation.

Result

The median follow-up period was 24 months (11–43 months), during which in 40 patients (66.66 %) the fistulas remained closed, with a zero rate of faecal incontinence. The results of the quality of life questionnaires are comparable (indeed, they are better in some items for the cured patients) to those of the reference population.

Conclusion

In our opinion, this procedure is safe and its results are promising in terms of clinical outcome and medium- to long-term quality of life.

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