title: Treatment of Crohn's disease-related high perianal fistulas combining the mucosa advancement flap with platelet-rich plasma: a pilot study.
abstract: BACKGROUND
  Healing rates after surgical closure for high perianal fistula in patients with Crohn's disease are even more disappointing than in patients with cryptoglandular fistulas. The objective was to improve healing rates by combining the well-known mucosal advancement flap with platelet-rich plasma.
  
  
  METHODS
  A prospective pilot study was conducted in one tertiary referral centre. Consecutive patients with primary or recurrent Crohn's disease-related high perianal fistulas, defined as involving the middle and/or upper third parts of the anal sphincter complex, were included. A staged procedure was performed with non-cutting seton treatment for 3 months first, followed by a mucosal advancement flap with injection of platelet-rich plasma into the fistula tract.
  
  
  RESULTS
  Ten consecutive patients were operated on between 2009 and 2014. Half (50%) of the patients had undergone previous fistula surgery. Mean follow-up was 23.3 months (SD 13.0). Healing of the fistula was 70% (95% confidence interval, 33-89%) at 1 year. One (10%) patient had a recurrence, and in two (20%) patients, the fistula was persistent after treatment. An abscess occurred in one (10%) patient. The median post-operative Vaizey score was 8.0 (range 0-21), indicating a moderate to severe continence impairment.
  
  
  CONCLUSIONS
  The results of combining the mucosal advancement flap with platelet-rich plasma in patients with Crohn's disease-related high perianal fistulas are moderate with a healing rate of 70%. Further investigation is needed to determine the benefits and risks on continence status for this technique in this patient population.
authors.affiliation: Department of Surgery and Colorectal Surgery, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands, k.gottgens@me.com.
authors.forename: K W A
authors.initials: KW
authors.lastname: Göttgens
authors.forename: R R
authors.initials: RR
authors.lastname: Smeets
authors.forename: L P S
authors.initials: LP
authors.lastname: Stassen
authors.forename: G L
authors.initials: GL
authors.lastname: Beets
authors.forename: M
authors.initials: M
authors.lastname: Pierik
authors.forename: S O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D053657:Platelet-Rich Plasma / Q000187:drug effects*; D011446:Prospective Studies; D012003:Rectal Fistula / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing