An Experimentally Successful New Sphincter-Conserving Treatment for Anal Fistula

• Published in: Diseases of the colon & rectum Vol. 52; no. 4; pp. 602 - 608
• Main Authors: Himpson, Rebecca C, Cohen, C. Richard G, Sibbons, Paul, Phillips, Robin K. S
• Format: Journal Article
• Language: English
• Published: United States The ASCRS 01.04.2009
• Subjects: Anal Canal; Animals; Biocompatible Materials - administration & dosage; Collagen - administration & dosage; Disease Models, Animal; Female; Injections, Intralesional; Rectal Fistula - pathology; Rectal Fistula - surgery; Swine
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/DCR.0b013e31819ece3e

PURPOSE:A new sphincter-conserving treatment was evaluated in a porcine model. METHODS:A total of 36 fistulas were created by procedures that have been published previously. At fistula induction a skin biopsy was taken from which to culture fibroblasts. Four weeks after induction, when fistulas were well established, the fistula tracks were cored out. Collagen paste modified from Permacol™ injection (Covidien, Mansfield, MA) was then used as a solitary infill material in 11 tracks, cultured autologous fibroblasts being added to this in a further 18 tracks. The track was cored out in seven controls, but these tracks were not treated with infill material. All of the internal and external openings were closed. Anorectal excision was then carried out under terminal anesthesia at 2 to 12 weeks. Histologic examination of individual tracks was performed by an experienced pathologist. RESULTS:In this quadruped all of the infilled tracks healed, autologous fibroblasts having the best tissue integration, but only two of seven control tracks healed. CONCLUSIONS:Removal of the fistula track followed by injection of collagen healed all of the cases. The addition of autologous fibroblasts improved the histologic appearance of the tracks. A pilot study in human fistula patients is in progress.