BACKGROUND: The long-term closure rate of high perianal fistulas after treatment remains disappointing. OBJECTIVE: The goal of this study was the long-term closure rate of high cryptoglandular perianal fistulas mucosal advancement flap with platelet-rich plasma. DESIGN: This study retrospective in design. SETTING: This study was conducted at 2 tertiary referral hospitals. PATIENTS: Patients presenting with high cryptoglandular perianal fistulas involving the middle/upper third of sphincter complex were included. INTERVENTIONS: A staged surgical performed; After seton placement, a mucosal advancement flap was platelet-rich plasma. MAIN OUTCOME MEASURES: Recurrence was the main Incontinence was the secondary outcome. RESULTS: We operated on 25 between 2006 and 2012. Thirteen (52%) patients had previous fistula median follow-up period was 27 months. One patient (4.0%) was lost to after 4 months. Freedom from recurrence at 2 years was 0.83 (95% CI, Two of the 4 patients with a recurrence (8%) had a repeated treatment One patient (4.0%) refused another treatment, but agreed to stay in One patient (4.0%) requested a colostomy, resulting in closure of the Complications occurred in 1 patient (4.0%). Incontinence numbers were median Vaizey score of 3.0 out of a maximum of 24. LIMITATIONS: The limited by its retrospective design, lack of preoperative incontinence selection bias, and phone interview follow-up. CONCLUSION: The long-term results of patients with primary and recurrent high cryptoglandular fistulas treated with a seton followed by mucosal advancement flap and platelet-rich plasma show low recurrence, complication, and incontinence Therefore, this technique seems to be a valid option as treatment. preferably randomized controlled studies are needed to further explore surgical technique.
Gottgens, K. W., Vening, W., van der Hagen, S. J., van Gemert, W. G., Smeets, R. R., Stassen, L. P., Baeten, C. G., & Breukink, S. (2014). Long-term Results of Mucosal Advancement Flap Combined With Platelet-rich Plasma for High Cryptoglandular Perianal Fistulas. Diseases of the Colon & Rectum, 57(2), 223-227. https://doi.org/10.1097/DCR.0000000000000023