Addition of Platelet-Rich Plasma to Endorectal Advancement Flap Repair Does Not Enhance the Healing of Cryptoglandular Transsphincteric Fistulas

BACKGROUND: 

Endorectal advancement flap repair is often performed for the treatment of cryptoglandular transsphincteric fistulas. However, this procedure fails in approximately 1 of 4 patients. Based on its supposed healing properties, platelet-rich plasma might enhance the outcome of this procedure. 

OBJECTIVE: 

To evaluate and compare the short-term and long-term outcomes after endorectal advancement flap repair with and without platelet-rich plasma injection in patients with a cryptoglandular transsphincteric fistula. 

DESIGN: 

Retrospective cohort study. 

SETTING: 

Tertiary referral hospital for proctology in the Netherlands. 

PATIENTS: 

Consecutive patients with a cryptoglandular transsphincteric fistula. Inverse propensity score-weighted comparison was used to adjust for confounding and selection bias.

INTERVENTIONS: 

Endorectal advancement flap repair with and without platelet-rich plasma injection. 

MAIN OUTCOME MEASURES: 

Clinical fistula closure within 1 year without need for a reintervention (primary healing), clinical fistula closure within 1 year corrected for reinterventions (secondary healing), overall fistula healing within 1 year, and long-term outcomes assessed by a questionnaire. 

RESULTS: 

In total, 219 patients underwent an endorectal advancement flap repair. In 88 patients (40.2%), platelet-rich plasma was injected. No significant difference was observed in primary healing (67.0% vs 69.5%, p = 0.71), secondary healing (37.5% vs 43.5%, p = 0.60), or overall healing (73.9% vs 77.1%, p = 0.58) between patients treated with and without platelet-rich plasma injection. Long-term follow-up was available in 67.1% of the patients with a mean follow-up of 6.8 years (SD: 3.7 years). Among all patients who reached fistula healing, whether primary or secondary, within 1 year and had available long-term follow-up data, recurrence rates were also not significantly different (6.3% vs 2.9%, p = 0.37). Propensity score-weighted analysis showed that patients treated with a platelet-rich plasma injection were not more likely to achieve primary healing (OR 1.0; 95% CI, 0.5-1.9), secondary healing (OR 1.1; 95% CI, 0.2-3.2), overall healing (OR 0.9; 95% CI, 0.5-1.7), or recurrence at long-term follow-up (OR 1.1; 95% CI, 0.4-18.8) compared with patients without platelet-rich plasma injection.

LIMITATIONS: 

Retrospective design, lack of postoperative imaging, and assessment of long-term follow-up using a questionnaire. 

CONCLUSION: 

Addition of platelet-rich plasma injection does not improve the short-term and long-term outcomes of endorectal advancement flap repair in patients with a cryptoglandular transsphincteric fistula treated in a tertiary referral center.