Collagen treatment of complex anorectal fistula: 3 years follow-up

Author:

Maternini Matteo1,Guttadauro Angelo1,Avella Pasquale2,Buondonno Antonio2,Mascagni Domenico3,Milito Giovanni4,Stuto Angelo5,Renzi Adolfo6,Rennis Maria7,Bottini Corrado8,Quarto Gennaro9,Nudo Raffaele10,Del Re Luca11,Amato Bruno12,Gabrielli Francesco1

Affiliation:

1. General Surgery Department, Istituti clinici Zucchi of Monza, University of Milano-Bicocca , 20126 , Milan , Italy

2. Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, Via Francesco De Sanctis 1 , 86100 , Campobasso , Italy

3. General Surgery Department, Policlinico Umberto I, University La Sapienza of Rome , 00161 , Rome , Italy

4. General Surgery Department, University Hospital of Roma “Tor Vergata,” 00133 , Rome , Italy

5. General Surgery Department, IRCCS Policlinico San Donato of Milano , 20097 , Milan , Italy

6. General Surgery Department, Clinica Villa Delle Querce , 80136 , Naples , Italy

7. General Surgery Department, Ospedale San Gerardo di Monza, University of Milano-Bicocca , 20900 , Milan , Italy

8. General Surgery Department, Hospital of Gallarate , 21013 , Varese , Italy

9. Department of Clinical Medicine and Surgery, University of Naples “Federico II,” Via S. Pansini, 5 , 80131 Naples , Italy

10. General Surgery Department, Casa di Cura Fabia Mater , 00171 , Rome , Italy

11. General Surgery Department, Ospedale Multimedica San Giuseppe of Milano , 20123 , Milan Italy

12. Department of Public Health, University of Naples “Federico II,” Via S. Pansini, 5 , 80131 Naples , Italy

Abstract

Abstract Fistula in ano is a common anorectal disease in adults. Currently, surgery remains the definitive therapeutic approach, but in some cases, it can lead to serious complications as faecal or gas incontinence. Therefore, sphincter sparing treatments should be considered for complex fistulas. One of the sphincteric preserving treatment is the filling with a dermal extract commonly called “collagen glue” as Salvecoll-E® gel. This is a multicentric, prospective, observational study on the use of Salvecoll-E® gel in treatment of complex anal fistulas. We treated 70 patients from May 2016 to May 2017. In the first phase, we debrided the fistula tract using a loose seton kept for 4–6 weeks. In the second phase, the seton was removed and the fistula tract was filled with Salvecoll-E® gel. In this article, we report results at 36 months of follow-up. Fifty patients (71.4%) had completely healed fistula within 36 months of follow-up. Twenty-eight patients (28.2%) had recurrences. Among these failures, 65% were within 6 months. All low transphincteric fistulas healed. Recurrences occurred only in median and high transphincteric fistulas. No patient had a worsening of continence status measured with Cleveland Clinic Florida Incontinence Severity score. Salvecoll-E® gel is a recent finding among sphincter-sparing treatments. In this study, we demonstrate that it is a safe option in the treatment of complex fistulas. Final results are satisfactory and in line with the best results published in literature among mini-invasive treatments.

Publisher

Walter de Gruyter GmbH

Subject

General Medicine

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