title: Long-term results of mucosal advancement flap combined with platelet-rich plasma for high cryptoglandular perianal fistulas.
abstract: BACKGROUND
  The long-term closure rate of high perianal fistulas after surgical treatment remains disappointing.
  
  
  OBJECTIVE
  The goal of this study was to improve the long-term closure rate of high cryptoglandular perianal fistulas combining mucosal advancement flap with platelet-rich plasma.
  
  
  METHODS
  This study was retrospective in design.
  
  
  METHODS
  This study was conducted at 2 secondary and 1 tertiary referral hospitals.
  
  
  METHODS
  Patients presenting with high cryptoglandular perianal fistulas involving the middle/upper third of the anal sphincter complex were included.
  
  
  METHODS
  A staged surgical treatment was performed; After seton placement, a mucosal advancement flap was combined with platelet-rich plasma.
  
  
  METHODS
  Recurrence was the main outcome. Incontinence was the secondary outcome.
  
  
  RESULTS
  We operated on 25 patients between 2006 and 2012. Thirteen (52%) patients had previous fistula surgery. The median follow-up period was 27 months. One patient (4.0%) was lost to follow-up after 4 months. Freedom from recurrence at 2 years was 0.83 (95% CI, 0.62-0.93). Two of the 4 patients with a recurrence (8%) had a repeated treatment and healed. One patient (4.0%) refused another treatment, but agreed to stay in follow-up. One patient (4.0%) requested a colostomy, resulting in closure of the fistula. Complications occurred in 1 patient (4.0%). Incontinence numbers were low with a median Vaizey score of 3.0 out of a maximum of 24.
  
  
  CONCLUSIONS
  The study was limited by its retrospective design, lack of preoperative incontinence data, selection bias, and phone interview follow-up.
  
  
  CONCLUSIONS
  The long-term outcome results of patients with primary and recurrent high cryptoglandular perianal fistulas treated with a seton followed by mucosal advancement flap and platelet-rich plasma show low recurrence, complication, and incontinence rates. Therefore, this technique seems to be a valid option as treatment. Larger and preferably randomized controlled studies are needed to further explore this surgical technique.
authors.affiliation: 1Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Maastricht, The Netherlands 2Department of Surgery and Colorectal Surgery, Refaja Hospital, Stadskanaal, The Netherlands 3Department of Surgery and Colorectal Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Göttgens
authors.forename: Wouter
authors.initials: W
authors.lastname: Vening
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: van der Hagen
authors.forename: Wim G
authors.initials: WG
authors.lastname: van Gemert
authors.forename: Reinier R
authors.initials: RR
authors.lastname: Smeets
authors.forename: Laurents P
authors.initials: LP
authors.lastname: Stassen
authors.forename: Cor G
authors.initials: CG
authors.lastname: Baeten
authors.forename: Stephanie O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D053657:Platelet-Rich Plasma; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult