Abstract
Optimal surgical treatment for anal fistula should result in healing of the fistula track and preserve anal continence. The aim of this study was to evaluate Permacol™ collagen paste (Covidien plc, Gosport, Hampshire, UK) injection for the treatment of complex anal fistulas, reporting feasibility, safety, outcome and functional results. Between May 2013 and December 2014, 21 consecutive patients underwent Permacol paste injection for complex anal fistula at our institutions. All patients underwent fistulectomy and seton placement 6-8weeks before Permacol™ paste injection. Follow-up duration was 12months. Eighteen patients (85.7%) had a high transsphincteric anal fistula, and three female patients (14.3%) had an anterior transsphincteric fistula. Fistulas were recurrent in three patients (14.3%). Seven patients (33%) had a fistula with multiple tracts. After a follow-up of 12months, ten patients were considered healed (overall success rate 47.6%). The mean preoperative FISI score was 0.33±0.57 and 0.61±1.02 after 12months. Permacol™ paste injection was safe and effective in some patients with complex anal fistula without compromising continence.
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