title: Fistula tract curettage and the use of biological dermal plugs improve high transsphincteric fistula healing in an animal model.
abstract: OBJECTIVE
  The treatment of high transsphincteric fistula is a complex procedure, which may be associated with the risk of recurrence and fecal incontinence. In this study, we used an animal model to compare different types of sphincter-preserving treatments for transsphincteric fistula.
  
  
  METHODS
  Sixteen female New Zealand rabbits, weighing 2.8-4.8 kg underwent a surgical creation of high transsphincteric fistula. After 6 weeks, magnetic resonance imaging (MRI) was performed in order to confirm fistula formation and measure the fistula diameter. The rabbits were divided into three groups. Group 1 received no plug treatment (control). Autologous dermal graft and acellular dermal matrix were used as a plug in groups 2 and 3, respectively. Five weeks after treatment, fistula tract healing was determined by measuring the largest fistula diameter with MRI. All rabbits were euthanized and the anorectum excised en bloc for histopathological examination.
  
  
  RESULTS
  According to the MRI findings, all groups showed significant healing after the treatment (p < 0.05). The healing rate of fistula diameters after treatment was 40, 66, and 29% in the control, dermal graft, and acellular dermal matrix groups, respectively. In terms of negative healing parameters such as neutrophil, eosinophil, lymphocyte, and plasmocyte accumulation, dermal graft and acellular dermal matrix groups showed significantly lower results than those in the control group (p < 0.05).
  
  
  CONCLUSIONS
  According to MRI and histopathological results, fistula tract curettage and fistula orifice closure improved transsphincteric anal fistula healing. Additionally, in this study, plug treatment favoring autologous dermal graft resulted in better healing.
authors: Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Cigdem
authors: C
authors: Benlice
authors: Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Merve
authors: M
authors: Yildiz
authors: Department of Plastic and Reconstructive Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Semih
authors: S
authors: Baghaki
authors: Department of General Surgery, Maslak Acibadem Hospital, Medical School, Acibadem University, Istanbul, Turkey.
authors: Ilknur
authors: I
authors: Erguner
authors: Department of Radiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Deniz Cebi
authors: DC
authors: Olgun
authors: Department of Pathology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Sebnem
authors: S
authors: Batur
authors: Department of Pathology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Sibel
authors: S
authors: Erdamar
authors: Department of Biostatistics, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors: Pinar
authors: P
authors: Ambarcioglu
authors: Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.|Department of General Surgery, Maslak Acibadem Hospital, Istanbul, Turkey.
authors: Ismail
authors: I
authors: Hamzaoglu
authors: Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.|Department of General Surgery, Maslak Acibadem Hospital, Istanbul, Turkey.
authors: Tayfun
authors: T
authors: Karahasanoglu
authors: Department of General Surgery, Atakent Acibadem Hospital, Medical School, Acibadem University, Istanbul, Turkey. bilgibaca@hotmail.com.
authors: Bilgi
authors: B
authors: Baca
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D003475:Curettage / Q000379:methods*; D004195:Disease Models, Animal; D005260:Female; D005401:Fissure in Ano / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011817:Rabbits; D016038:Skin Transplantation; D014182:Transplantation, Autologous; D014945:Wound Healing
keywords: Acellular dermal matrix; Autologous dermal graft; Fistula curettage; Transphincteric anal fistula