Abstract
Background
Surgical management of perianal fistula (PF) is complicated by a high rate of recurrence and risk of damage to the sphincter complex. Advances in surgical techniques and the use of traditional and biologic fistula plugs have demonstrated recent success. However, the need for minimally invasive, cost-effective techniques capable of lower recurrence rates still exists. Ovine forestomach matrix (OFM) is a biologic graft capable of regenerating healthy native tissue and was used for the surgical management in PFs in this study.
Methods
This retrospective case-series analyzed data collected from 25 patients at a single site treated with OFM for various perianal fistula subtypes as a key component of the surgical treatment algorithm. The primary outcome was healing status at 12 weeks. Secondary outcomes included time to complete closure, recurrence at follow-up intervals, and post-operative complications.
Results
The most common PF subtype was a trans-sphincteric fistula (72%) and of primary and cryptoglandular origin. Mean PF depth was 3.3 ± 1.6 cm with a 76% incidence of healing at 12-weeks and a median time to closure of 4.5 weeks (IQR: 4.0, 6.0). At last follow-up, 21 of 25 PFs were completely healed (84%) with one recurrence at a median follow-up time of 25 weeks (IQR: 15.5, 29.5). Eighty percent of patients reported no pain at post-operative follow-up.
Conclusion
OFM was found to be a safe, efficacious, and cost-effective treatment for the surgical management of perianal fistula. At last follow-up, OFM achieved successful closure with no recurrences using a median single device implantation.