Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Techniques in Coloproctology
Published in: Techniques in Coloproctology 3/2017

01-03-2017 | Original Article

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

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

Published in: Techniques in Coloproctology | Issue 3/2017

Login to get access

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.
Literature
1.
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.
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.
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.
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.
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.
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.
Ellis CN (2007) Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ 64(1):36–40CrossRefPubMed
9.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Westerterp M, Volkers NA, Poolman RW, van Tets WF (2003) Anal fistulotomy between Skylla and Charybdis. Colorectal Dis 5:549–551CrossRefPubMed
22.
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.
Ritchie RD, Sackier JM, Hodde JP (2009) Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 11(6):564–571CrossRefPubMed
24.
25.
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.
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.
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.
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.
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.
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.
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.
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.
Soltani A, Kaiser AM (2010) Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum 53(4):486–495CrossRefPubMed
Metadata
Title
Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up
Authors
B. Fabiani
C. Menconi
J. Martellucci
I. Giani
G. Toniolo
G. Naldini
Publication date
01-03-2017
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 3/2017
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-017-1590-3

Other articles of this Issue 3/2017

Techniques in Coloproctology 3/2017 Go to the issue

Review

Systematic review: the impact of exercise on mesenteric blood flow and its implication for preoperative rehabilitation

Controversies in Colorectal Surgery

Laparoscopic surgery for rectal cancer: the verdict is not final yet!

Review

Midterm outcomes of injectable bulking agents for fecal incontinence: a systematic review and meta-analysis

Trick of the Trade

LBet 88: a new device for outpatient treatment of selected grade III hemorrhoids

Multimedia Article

Combined transanal total mesorectal excision (taTME) with laparoscopic instruments and abdominal robotic surgery in rectal cancer

Correspondence

Is the term “intersphincteric dissection” anatomically appropriate?