title: Platelet-rich fibrin sealant as a treatment for complex perianal fistulas: a multicentre study.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Digestive Surgeon, Service of Surgery, Hospital de Antequera, Málaga, Spain, javinewyork@hotmail.com.
authors.forename: F J Pérez
authors.initials: FJ
authors.lastname: Lara
authors.forename: A Moreno
authors.initials: AM
authors.lastname: Serrano
authors.forename: J Ulecia
authors.initials: JU
authors.lastname: Moreno
authors.forename: J Hernández
authors.initials: JH
authors.lastname: Carmona
authors.forename: M Ferrer
authors.initials: MF
authors.lastname: Marquez
authors.forename: L Romero
authors.initials: LR
authors.lastname: Pérez
authors.forename: A
authors.initials: A
authors.lastname: del Rey Moreno
authors.forename: H Oliva
authors.initials: HO
authors.lastname: Muñoz
mesh_terms: D000328:Adult; D001792:Blood Platelets; D003475:Curettage; D017577:Cutaneous Fistula / Q000150:complications / Q000628:therapy*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012003:Rectal Fistula / Q000150:complications / Q000628:therapy*; D012008:Recurrence; D011795:Surveys and Questionnaires; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives