Freeze-dried collagen implant for the surgical treatment of trans-sphincteric anal fistula

Abstract

The aim — to improve the surgical treatment results of trans­sphincteric anal fistulas with freeze­dried collagen implant.Materials and methods. 88 patients with trans­sphincteric fistulas of rectum were operated in the of Surgery and Proctology Department from 2012 to 2017. Patients were aged 25 to 65 years old, average age constituted 54.3 ± 2.1 years. Men — 54 (61.3 %), women — 32 (38.7 %). A transanal ultrasound study with complex substance and a circular image sensor (5 — 7.5 MHz) was performed in all patients. 32 patients (36.4 %) had front, 26 (29.5 %) — lateral and 30 (34.1 %) — posterior fistulas, according to the study. Patients were divided into 2 groups depending on the method of surgical treatment. First group comprised 44 patients who were treated with the freeze­dried allogeneic collagen implant by original technic and a comparison group of 44 patients who used traditional surgical treatment methods of rectal fistulas (the fistula excision in the lumen of the gut — in 28 (63.6 %) observations, Seton Placement (ligation) — in 16 (36.4 %)). The effectiveness of operations was assessed by comparing the immediate and long­term results.Results and discussion. 2 patients (4.5 %) in the first group appeared to have wound abscess, 4 (9.1 %) — serous inflammation of operative wound. Anal incontinence was hardly in evidence. The wound healed on 10.0 ± 1.1 day. In the comparison group, local complications were observed in the early postoperative period in the form of wound suppuration in 9 (20.4 %) patients, partial incontinence of gases in 10 (22.7 %), anal incontinence of the first degree in 8 (18.9 %) %), persistent anal incontinence — in 6 (13.6 %). The wound healed on average 24.0 ± 2.1 days. Long­term results of treatment (1 to 24 months) were examined by observation and questioning of 42 patients in the main group and 41 — in comparison groups. Relapse of the disease in the main group occurred in 2 (4.7 %) patients, in the comparison group — in 7 (17.1 %). In the comparison group, stable anal incontinence was also observed in 6 (14.6 %) and partial incontinence in 8 (19.5 %).Conclusions. Surgical treatment of trans­sphincteric fistulas with freeze­dried collagen implant provides ensures reliable closure of the internal fistula opening and helps reduce the relapse rate to 4.7 compared to 17.1 % using traditional techniques.