Treatment Of Fistula Research Articles

Efficacy and safety of stem cell therapy for fistula management: An overview of existing systematic reviews.

Fistulas, abnormal connections between two anatomical structures, significantly impact the quality of life and can result from a variety of causes, including congenital defects, inflammatory conditions, and surgical complications. Stem cell therapy has emerged as a promising alternative due to its potential for regenerative and immunomodulatory effects. This overview of systematic reviews aimed to assess the safety and efficacy of stem cell therapy in managing fistulas, drawing on the evidence available. This umbrella review was conducted following the Joanna Briggs Institute (JBI) methodology to assess the efficacy and safety of stem cell therapy for treating various types of fistulas. A comprehensive search was performed across multiple electronic databases including PubMed, Embase, Cochrane Register, and Web of Science up to May 5th, 2024. Systematic reviews focusing on stem cell therapy for fistulas were included, with data extracted on study design, stem cell types, administration methods, and outcomes. The quality of the reviews was assessed using the AMSTAR 2 tool, and meta-analyses were conducted using R software version 4.3. Nineteen systematic reviews were included in our umbrella review. The stem cell therapy demonstrated by significant improvements in clinical remission rates, with a relative risk (RR) of 1.299 (95% CI: 1.192 to 1.420). Stem cell therapy enhanced fistula closure rates, both short-term (RR=1.481; 95% CI: 1.036 to 2.116) and long-term (RR=1.422; 95% CI: 1.091 to 1.854). The safety analysis revealed no significant increase in the risk of adverse events with stem cell therapy, showing a pooled RR of 0.972 (95% CI: 0.739 to 1.278) for general adverse events and 1.136 (95% CI: 0.821 to 1.572) for serious adverse events, both of which indicate a safety profile comparable to control treatments. Re-epithelialization rates also improved (RR=1.44; 95% CI: 1.322 to 1.572). Stem cell therapy shows promise as an effective and safe treatment for fistulas, particularly in inducing remission and promoting closure of complex fistulas. The findings advocate for further high-quality research to confirm these benefits and potentially incorporate stem cell therapy into standard clinical practice for fistula management. Future studies should focus on long-term outcomes and refining stem cell treatment protocols to optimize therapeutic efficacy.

Treatment of Oroantral Communication and Fistulas with the Use of Blood-Derived Platelet-Rich Preparations Rich in Growth Factors: A Systematic Review

The formation of an oroantral communication (OAC) or fistula (OAF) is a rare complication resulting from the presence of processes in the lateral parts of the maxilla or for iatrogenic reasons. The most common causes of OAC or OAF are tooth extraction with periapical lesions. The aims of this systematic review were to assess the use of platelet-derived preparations rich in growth factors in the treatment of OAC or OAF, to determine the success of treating the communication or fistula, as well as impact on postoperative complications and the course of healing. The study was performed following PRISMA guidelines (PROSPERO: CRD42024570758). The inclusion criteria were as follows: at least ten patients, the presence of oroantral communication or oroantral fistula, treatment with platelet-derived preparations rich in growth factors, and information regarding the response to treatment. In order to find relevant studies, international databases, including PubMed, Google Scholar, Web of Science Core Collection, MDPI, Wiley, and Cochrane Library were searched. The last search was performed on 31 August 2024. Seven articles were included in the systematic review. In total, platelet-derived preparations rich in growth factors were used in 164 patients. Only studies in which OAC was treated and with platelet-rich fibrin (PRF) met the inclusion criteria. Only PRF was used as the sole treatment method in three studies. When OAC is greater than 5 mm, platelet-derived preparations rich in growth factors should be considered adjuncts to treatment, not the sole treatment method. The success rate of OAC treatment was 90–100%. The use of blood products to close OAC may be an effective therapeutic alternative. Proper patient qualification and the use of an appropriate protocol are crucial. There is a need for future well-designed case-control or cohort studies as well as randomized controlled trials to provide the required level of evidence.

Childbearing after treatment for obstetric fistula: perspectives from survivors in Malawi

Women who suffer from an obstetric fistula endure more than just physical pain. Their ability or desire to bear children may also be affected due to physical damage to their reproductive organs. In addition, they may suffer from emotional trauma which is likely to affect their decision to have children. The aim of this study therefore was to explore in more detail the perspectives of obstetric fistula survivors about childbearing after treatment for their condition. This qualitative study was conducted at a non-governmental organisation in the Central Region of Malawi. Data was collected using in-depth interviews from 18 women who had suffered from an obstetric fistula. The study revealed that many women either had no further desire for children or were unable to bear children. Fear of dying and resulting pain from the fistula surgery deter women from wanting further pregnancies. However, there was still strong emphasis placed on childbearing, especially for the younger women who desired children as a means of maintaining their marriages. The risk of further pregnancies and mitigation strategies for reducing obstetric fistulas, should be fully communicated to women. Those who become infertile as a result of obstetric fistula may also require appropriate counselling.

Clinical presentation and treatment of a bronchocutaneous fistula with intrathoracic abscessation in a yearling

SummaryThis case report describes the clinical presentation, surgical treatment, post‐operative management and outcome of a bronchocutaneous fistula with intrathoracic abscessation in a yearling horse. The animal was presented with a history of several months of persistent coughing and a cutaneous fistula located over the right ventral hemithorax. The yearling had purulent discharge similar in character from both nares and draining out of the fistula. A bronchocutaneous fistula with intrathoracic abscessation was diagnosed by endoscopic examination of the cutaneous fistula. The treatment initially consisted of cyanoacrylate applied topically to the affected bronchi under endoscopic guidance, which was not successful. The fistula was successfully sealed with a diode laser used to create local inflammation at the site. One week after the second intervention, the patient's clinical signs resolved and the fistula was completely sealed 10 weeks following intervention. Follow‐up at 16 months revealed that the patient was doing well and clinically normal.

Possibilities of endovascular treatment of vascular complications in mine–blast trauma

Objective. To optimize approaches to endovascular treatment of posttraumatic false aneurysms and arteriovenous fistulas in patients with complications of mine–blast trauma. Materials and Methods. The results of examination and treatment of 9 patients with complications of mine–blast trauma were analyzed. False aneurysms of various localizations were detected in 5 (55.6%) patients, and arteriovenous fistulas of the same localization were detected in 4 (44.4%) patients. Results. We performed 5 endoprosthetics with the use of stent grafts to exclude lesions from the circulation, as well as 5 selective embolizations with coils. In 1 patient, embolization with endoprosthetics was performed simultaneously. In all 9 patients, the treatment was technically successful, that is, the technical success of the interventions was 100%. None of the patients had any complications. All patients regressed clinical symptoms after the intervention. Conclusions. Endovascular treatment of post–traumatic false aneurysms and arteriovenous fistulas in patients with mine–blast trauma is highly effective. In all 9 patients with arteriovenous fistulas and false aneurysms, endoprosthetics with stent grafts and selective embolization of lesions with complex anatomy were successfully performed. Further study of the long–term results of treatment of these patients is necessary to increase technical and clinical success.

A Successful Case of Using a New Method of Surgical Treatment of Patients with Transsphincteric Pararectal Fistulas

INTRODUCTION: Surgical treatment of high transsphincteric and extrasphincteric pararectal fistulas (PFs) is one of the unsolved problems of modern coloproctological practice. Currently, there is no uniform approach in treatment of these kinds of PFs. AIM: To present a clinical case of successful application of the developed method of treatment of high transsphincteric PFs using resorbable АПТОС® threads with notches and antibacterial coating. The paper presents a case of application of the developed method for the treatment of high transsphincteric PFs using resorbable АПТОС® threads with notches and antibacterial coating in a patient admitted to a surgical department on a planned basis with complaints of the presence of a skin defect in the perianal area with permanent purulent discharge, periodic elevation of body temperature to 37.5°С–38.0°С accompanied by pain in the anus area. Detailed description of surgical intervention method is given. Within the first 3 days after the surgical intervention, low-grade body temperature persisted (37.3°С–37.5°С). The pain syndrome was most pronounced throughout the first postoperative day, in the following days analgesics were not required. On the 7th day, the patient was discharged in satisfactory condition under supervision of a surgeon at the local clinic. On the control examinations at 1 and 6 months, no data on recurrence, anal incontinence were obtained. CONCLUSION: The presented clinical case demonstrates reasonability and effectiveness of the method developed by authors for surgical treatment of high transsphincteric PFs with use of resorbable АПТОС® threads with notches and antibacterial coating.

Comparison of a Novel Liquid Embolic System with Commonly Used Embolic Agents in the Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas: A Single-Center Experience

Background/Objectives: Endovascular embolization is an effective treatment option for cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (DAVFs). The objective of this study was to assess the safety and efficacy of MenoxTM in patients with cranial dural arteriovenous fistulas. Methods: From January 2021 to January 2023, 19 patients with intracranial DAVFs underwent embolization procedures. All patients were treated by embolization with MenoxTM or/and in combination with other embolization products such as Onyx (Covidien, Irvine, California), PHIL (MicroVention, Tustin, California), and Squid (Balt Extrusion, Montmorency, France). Treatment approaches were selected depending on the anatomical location of the fistula. Patients were monitored and followed-up for 12 months. Results: The patients’ mean age was 56.26 ± 16.49 years. Of these 19 patients, 58% (n = 11) were treated with the MenoxTM liquid embolizing agent (LEA) alone or in combination with different LEAs, while n = 7 were treated with other LEAs and 1 patient was treated solely with coils. Complete occlusion of DAVFs with MenoxTM and other agents was evident in 68.4% (n = 13/19) of patients. Complete occlusion (100%) was observed in the sinus rectus, transverse sinus, and diploic veins of the orbital roof, while complete occlusion was observed in 50% of falcotentorial patients and 60% of superior sagittal sinus patients. The lowest rate of complete fistula obliteration was observed in the dural carotid cavernous fistula (CCF) group (25%). An intra-procedural adverse event occurred in one patient. No other post-procedural adverse events were noted. Furthermore, in patients treated with MenoxTM, total occlusion was achieved in 72.7% (n = 8) of patients, whereas the non-MenoxTM group had 62.5% (n = 5) of patients with 100% occlusion and 37.5% (n = 3) of patients with subtotal occlusion. Conclusions: Outcomes using MenoxTM alone and in combination with other agents were effective, and it is safe for the treatment of dural arteriovenous fistulas.

Lymphatic Fistula Treatment: Indocyanine Green Lymphography-guided Microsurgery

Background: Lymphatic fistulas are a common complication from surgery or interventional procedures resulting in persistent lymphatic leakage and delayed wound healing. The management of lymphatic fistula remains a subject of debate, ranging from conservative treatment to surgical lymphatic ligation. The implementation of a novel microsurgical approach involving lymphatic fistula ligation and/or lymphovenous anastomosis (LVA) using indocyanine green (ICG) lymphography is expected to decrease occurrence and complications. In this study, we share our experience in treating lymphatic fistula–guided microsurgical treatment. Methods: A total of 13 patients from our hospital with persistent lymphatic fistula were enrolled in this retrospective study. Lymphatic fistulas and their leakages were identified and ligated by using ICG lymphography and a surgical microscope. In two cases, additional LVA surgery was performed. Results: We were able to precisely identify lymphatic fistulas and treat them in all 13 patients. Lymph ligation was performed in all 13 cases, with additional distal LVA in two cases. In all patients, wound healing occurred following lymphatic ligation, except in one patient due to persistent infection. Patients with a lymphatic fistula were referred to our unit within 3 weeks to 1 year after onset, with an average consultation occurring after 5 months of persistent lymphatic fistula. Conclusions: Targeted lymphatic vessel ligation with or without LVA with ICG-guided surgical microscope represents a promising highly efficacious therapy for persistent lymphatic fistula. This technique may accelerate wound healing and reduce hospitalization duration, thus advocating for its preferential use in managing lymphatic fistulas.

A population-based study of incidence, aetiology, treatment and outcome of enterocutaneous fistula.

The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10-year period and to describe aetiology, treatments, care consumption and outcome. A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in-hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified. The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF-related in-hospital care until closure or end of follow-up was 4 (range 0-61) weeks. Eighty-eight patients (47%) received home-based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF-related death was 30.2%. This study defines the population-based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home-based healthcare.

Stereotactic radiosurgery as an alternative treatment for dural arteriovenous fistula

Unlike cerebral arteriovenous malformation or cavernous malformation, dural arteriovenous fistula (DAVF) is an uncommon cerebrovascular malformation in clinical practice. However, the clinical treatment modalities for DAVFs have expanded in recent years. The standard treatment for DAVF is endovascular surgery. Endovascular surgery is an effective and safe treatment method if open surgical treatment is considered dangerous in a patient. Nonetheless, after endovascular embolization, additional treatment is often required due to insecure occlusion or procedure-related sequelae. Recent reports have demonstrated stereotactic radiosurgery (SRS) as an effective and safe alternative to conventional endovascular surgery. This review summarizes DAVF and SRS in general and proposes indications for SRS as an appropriate treatment option for DAVFs.

Optimizing Surgical Technique for Improved Fistula Treatment

Especially transphincteric anorectal fistulas have shown to be complex with involvement of many anatomical structures and rather high recurrence rates. The need for modularity in the annular dissecting fistula as well as in the sphincteric functioning became pronounced in treatment for the disorder. This is done so that conditions such as fecal incontinence are not realized in the process of undergoing surgery. The patient was a 52-year-old man with many symptoms of the disease including transphincteric fistula with many openings internally or externally. An example of a patient suitable for using the new surgical method for assessment of the outcome would be a patient with no clinical conditions such as diabetes or hypertension. This approach uses modern approaches in drainage together with the ancient Ayurveda technique of Kshara sutra technique in the treatment of the tissue in order to ensure that there is a constant drainage of the contents of the fistulous tract. Among all these techniques, methylene blue infiltration has been found quite helpful in identifying the fistula tract. These procedures are aimed at achieving maximum surgical effect which will minimize the possibility of the recurrence of the illness and enhance the muscular tone of the anal sphincter. The characteristics of the patient’s healing state also evolved in treatment: several changes were observed already on the 10th day after the operation. After the second month, the patient had no signs of the fistula tract any more: there were no recurrences or complications. Since there are neither other known influences that could significantly influence the general status of the patient, the presence of markers that could suggest how well the surgical intervention addressed the fistulas stresses the potential of the approach as a set of basic strategies for managing difficult fistulas. From the article, one may infer the important of precision and innovation in performing surgeries. Also, it has the potential to enhance patients’ outcome and exclude the factors of long-term adverse effects commonly seen in anorectal fistulas.

Presentation and treatment for reno-duodenal fistula in an acutely ill patient

Presentation and treatment for reno-duodenal fistula in an acutely ill patient

Different Surgical Approaches to the Treatment of Cleft Palate Fistulae as Perceived by Cleft Surgeons.

Palatal fistulas after palatoplasty could pose difficulties for both patients and surgeons. Numerous surgical approaches are available to treat palatal fistulas. In this manuscript, we investigate surgical treatment options for palatal fistula repair looking at the different anatomical locations, and we create a summary of surgical approaches to facilitate the decision-making process for palatal fistulae repair. In this cross-sectional survey, nine anonymized patient cases with palatal fistulae that differed in severity and anatomical location were presented to participants from the International Cleft Master Course in Amsterdam about "Palatal Fistulas". Participants were invited to participate in this survey. A total of 141 participants reported their preferred surgical treatment options for fistula repair at different anatomical locations. We created different options for fistula treatment, catalogued by fistula location. This overview gives the surgeon possible approaches for each location. If the soft palate is involved, this overview underscores the importance of including velopharyngeal insufficiency management into the fistula repair. For hard palate involvement, our overview lists techniques available for nasal lining repair and for oral lining repair in each region. We provide a comprehensive overview of potential surgical approaches to repair palatal fistulae. This inventory of techniques is grouped per location to support surgeons in their decision-making process when confronted with a palatal fistula.

Evagination method for rectovaginal fistulas

AIM: to assess early and late results of the evagination method for the treatment of rectovaginal fistulas (RVF) in patients with anal incontinence due to muscle defect in the anterior semicircle. PATIENTS AND METHODS: the study included 45 patients. The prevailing etiology of RVF was delivery lesion in 19/45(42.2 %). The median follow-up was 6 (4; 8.5) months. On day 30 after surgery, the outcome was assessed clinically. Late outcomes were assessed in all patients 3–12 months including clinical control, transanal ultrasound and sphincterometry. RESULTS: recurrence occurred in 9/45 (20 %) patients. The significant improvement of continence was revealed: in mean pressure in rest (p = 0.004), in maximum contraction pressure (p < 0.0001), in Wexner incontinence score (p < 0.0001). With a fistula opening less than 16 mm, the recurrence risk increases (p = 0.0003). CONCLUSIONS: the evagination method is effective option in extent septal defects and correcting additional analsphincter insufficiency.

Experience in the diagnosis and treatment of non-invasive bilateral carotid cavernous sinus fistula based on CT image examination

Carotid cavernous fistula is a rare but clinically important vascular abnormality that is challenging to diagnose and treat. The clinical data of a patient with bilateral carotid cavernous fistula diagnosed by CT images were retrospectively analyzed. Through the analysis of CT images, the patient was accurately located and the diagnosis was confirmed. CT images can provide detailed anatomical information and accurately show the location, morphology and hemodynamic characteristics of carotid cavernous fistula. Through CT image examination, we successfully diagnosed bilateral carotid cavernous fistula patients, and can provide an important reference for surgical treatment. Therefore, CT image examination can provide accurate diagnosis and surgical planning information, and provide support for the formulation of individual treatment plans for patients. The application of this method is helpful to improve the early diagnosis rate and treatment effect of carotid cavernous fistula.

Minimally invasive treatment of an internal pancreaticopleural fistula with massive pleural effusion: a case report

BackgroundA pancreatic duct rupture can lead to various complications such as a fistula, pseudocyst, ascites, or walled-off necrosis. Due to pleural effusion, pancreaticopleural fistula typically causes dyspnea and chest pain. Leaks of enzyme-rich pancreatic fluid forming a pleural effusion can be verified in a thoracocentesis following radiological imaging such as computed tomography or magnetic resonance tomography. While management strategies range from a conservative to endoscopic and surgical approach, we report a case with successful minimally invasive treatment of pancreaticopleural fistula and effusion.Case presentationWe present a case of a patient with pancreaticopleural fistula and successful minimally invasive surgical treatment. A 62-year old Caucasian man presented with acute chest pain and dyspnea. A computed tomography scan identified a left-sided cystoid formation, extending from the abdominal cavity into the left hemithorax with concomitant pleural effusion. Pleural effusion analysis indicated significantly elevated pancreatic enzymes. Magnetic resonance cholangiopancreatography revealed a rupture of the pancreatic duct and nearby fluid accumulation. Endosonography later confirmed proximity to the tail of the pancreas, suggesting a pancreatic pseudocyst with visible tract into the pancreas. We assumed a pancreatic duct rupture with a fistula from the tail of the pancreas transdiaphragmatically into the left hemithorax with a commencing pleural empyema. A visceral and parietal decortication on the left hemithorax and a laparoscopic distal pancreatectomy with splenectomy was performed. The suspected diagnosis of a fistula arising from the pancreatic duct was confirmed histologically.ConclusionPancreaticopleural fistulas often have a long course and may remain undiagnosed for a long time. At this point diagnostic management and therapy demand a high level of expertise. In instances of unclear symptomatic pleural effusion, considering an abdominal focus is crucial. If endoscopic treatment is not feasible, minimally invasive surgery should strongly be considered, especially when located in the distal pancreas.

Catheter-Directed Glue Embolization for the Treatment of Bronchopleural Fistula with Associated Retained Microwave Ablation Needle Tip

Catheter-Directed Glue Embolization for the Treatment of Bronchopleural Fistula with Associated Retained Microwave Ablation Needle Tip

Effect of Stromal Vascular Fraction in the Rat Model of Pharyngocutaneous Fistulas.

A pharyngocutaneous fistula is one of the complications after laryngeal and pharyngeal surgery. It may also contribute to wound healing due to adipose tissue-derived stem cells and the growth factors in the stromal vascular fraction. The aim of this study was to investigate the effects of the adipose tissue-derived stromal vascular fraction on wound healing in the pharyngocutaneous fistula model induced in rats. Approval was received from the Animal Experiments Local Ethics Committee before starting the study (29.01.2016-2016/09). Eleven male Sprague-Dawley rats weighing approximately 300 g were included in the study. The animals were randomly divided into the study and control groups so that each group would include five animals. An animal was assigned as a donor for the removal of omental adipose tissue. Among the animals in which the pharyngocutaneous fistula model was created under general anesthesia, 1 ml of the stromal vascular fraction was injected into the study group on postoperative day 1. In postoperative week 2, all the animals were sacrificed and examined histologically (epithelialization-cell infiltration - mucosal injury). IBM SPSS Statistics for Windows, version 15, was used in the analyses. A p-value <0.05 was considered significant. Epithelialization was higher in the study group compared to the control group. However, no statistically significant difference was found between the two groups (p = 0.08). The cell infiltration was found to be statistically higher in the control group compared to the study group (p = 0.03). The mucosal injury was found to be significantly higher in the control group compared to the study group (p = 0.03). According to the Pearson correlation test, a negative correlation was found between epithelialization and cell infiltration and mucosal injury (p = 0.019 and p = 0.001). A positive correlation was found between cell infiltration and mucosal injury (p = 0.009). It was shown that stromal vascular fraction had a positive effect on wound healing in the pharyngocutaneous fistula model. According to the data we have obtained, we think that it can be effective in the treatment of pharyngocutaneous fistulas after more extensive preclinical and clinical studies are carried out.

Localized Administration of Mesenchymal Stem Cell-Derived Exosomes for the Treatment of Refractory Perianal Fistula in Crohn's Disease Patients: A Phase II Clinical Trial.

Crohn's disease perianal fistulae are often resistant to standard anti-TNF-α therapies. Mesenchymal stem cell (MSC)-derived exosomes are extracellular vesicles that have highly potent anti-inflammatory effects, and the previous phase of this study demonstrated their safety in the treatment of refractory perianal fistulas. To evaluate the efficacy of mesenchymal stem cell-derived exosomes for the treatment of refractory perianal fistulas. Nonrandomized, nonblinded single-center phase II clinical trial. Tertiary university hospital. Twenty-three patients were enrolled, 20 of whom completed the study. Refractory perianal fistula was defined as resistance to at least one course of treatment with anti-tumor necrosis facto-α therapy. After clinical assessment and magnetic resonance imaging, the patients were subjected to general anesthesia, and 5 mL of exosome solution was injected directly into the fistula tracts. The injections were repeated three times at 2-month intervals, and patients were followed monthly for 6 months after the last injection. Tissue samples from the tracts were obtained before each injection and subjected to immunohistopathological assessment. MRI data were obtained before and six months after the last injection. The primary outcome of this study was fistula tract closure on clinical examination and magnetic resonance imaging. The secondary outcome was an improvement in the discharge from the tracts. Fistula tracts were fully closed in 12 (60%) of the patients. Four patients showed clinical improvement, with some tracts remaining open, and four patients were completely resistant to treatment. A total of 43 fistula tracts were treated during the trial, 30 (69.7%) of which showed complete closure. Histopathological analysis revealed substantial reductions in local inflammation and signs of enhanced tissue regeneration. Immunohistochemical analysis of cluster of differentiation-68, 20 and 31 reaffirmed these results. MSC-derived exosomes are safe and effective for treating refractory perianal fistulas in patients with Crohn's disease. See Video Abstract.

Closing the internal opening with a rectal advancement flap increases the efficacy of mesenchymal stem cell injection for complex Crohn's disease anal fistulas.

The efficacy of injections of mesenchymal stem cells (MSC) for anal fistula treatment may be impaired by the persistence of stools passing into the fistula, causing bacterial contamination and a local inflammatory reaction. We aimed to compare remission rates between patients treated by MSC injection with simple sutures and those treated with a rectal advancement flap. This single-center prospective study compared the first patients who underwent internal opening closure with sutures with the subsequent patients treated with a flap. Complete clinical remission was defined as complete closure of the external opening(s) without pain or discharge, and complete radiological remission was defined as a Magnifi-CD score of 0. We compared the first 42 patients who had sutures with the 20 subsequent patients who had an advancement flap. The median follow-up was 15.5 [8.8-24.9]months. The cumulative incidence of complete clinical response at M12 was 53.8% [38.1-69.6%] in the suture group versus 93.3% [77.4-100.0] in the flap group (p < 0.001). The Magnifi-CD score was 0 for 41.7% [25.5-59.2%]) of patients treated with sutures versus 72.7% [39.0-63.9%]) of patients treated with a flap (p=0.093). Anal incontinence score did not differ between the two groups. Practicing an advancement flap was the only significant factor associated with complete clinical remission over time (adjusted HR [95% CI] of 2.6 [1.4-4.9], p = 0.003). Complete clinical remission rates following MSC injection are significantly higher after closure of the internal opening with a rectal flap than after closure with sutures, without consequences on anal continence.