Background

Complex perianal fistulas are a major challenge for modern surgery since 10–35% of patients have functional problems after treatment. Sphincter-saving techniques have a wide range of efficacy (10–80%). We hypothesised that autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma is a new therapeutic strategy with enhanced cure and function preservation rates.

Methods

Adult patients with complex cryptoglandular perianal fistulas were treated with injection of autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma around and inside the fistulous tract between May 2018 and April 2019 at the General and Emergency Surgery Operative Unit of the University Hospital “P. Giaccone” of Palermo. Fistulas were confirmed by magnetic resonance imaging. Patients completed the Short Form-36 score on quality of life and the Wexner and Vaizey scores on faecal incontinence, and they were functionally studied using a three-dimensional anorectal manometry. The clinical and functional follow-up was performed at 1 year and 2 years after surgery.

Results

Nine patients (4 males, 5 females; median age 42 years [19–63 years]) with high trans-sphincteric or horseshoe fistulas were treated. The average number of previous surgeries per patient was 4.8. At 1 year follow-up, 77.7% of patients were cured, while at 2 years there was 1case of relapse. The variation in Short Form-36 score in cured patients was not significant (p = 0.0936). No statistically significant differences were found in continence scores.

Conclusions

The proposed treatment is a treatment option that preserves sphincter integrity and function, potentially avoiding postoperative incontinence and the need of repeated treatments.

中文翻译：

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自体脂肪来源的基质血管成分和浓缩血小板用于治疗复杂的肛周瘘管

背景

复杂的肛周瘘管是现代外科手术面临的主要挑战，因为 10-35% 的患者在治疗后会出现功能问题。保括约肌技术具有广泛的功效 (10–80%)。我们假设自体脂肪来源的基质血管部分与富含血小板的血浆相结合是一种新的治疗策略，具有更高的治愈率和功能保存率。

方法

2018 年 5 月至 2019 年 4 月期间，在大学医院普通外科和急诊外科手术室，复杂隐腺性肛周瘘的成年患者接受了自体脂肪来源的间质血管部分与瘘管周围和内部富含血小板的血浆的联合治疗。 P. 巴勒莫的 Giaccone”。瘘管通过磁共振成像得到证实。患者完成了关于生活质量的 Short Form-36 评分和关于大便失禁的 Wexner 和 Vaizey 评分，并使用三维肛门直肠测压法对他们进行了功能研究。术后 1 年和 2 年进行临床和功能随访。

结果

9 名患有高位经括约肌或马蹄形瘘管的患者（4 名男性，5 名女性；中位年龄 42 岁 [19-63 岁]）接受了治疗。每位患者既往手术的平均次数为 4.8 次。随访1年，77.7%的患者治愈，2年复发1例。治愈患者的 Short Form-36 评分变化不显着 ( p  = 0.0936)。节制评分没有发现统计学上的显着差异。

结论

拟议的治疗是一种保留括约肌完整性和功能的治疗选择，可能避免术后失禁和重复治疗的需要。