Treatment of recurrent anal fistula using an autologous cartilage plug: a pilot study

• Published in: Techniques in coloproctology Vol. 19; no. 5; pp. 301 - 307
• Main Author: Ozturk, E.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.05.2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Anal Canal - surgery; Colorectal Surgery; Ear Cartilage - transplantation; Female; Gastroenterology; Humans; Male; Medical Illustration; Medicine; Medicine & Public Health; Middle Aged; Nasal Cartilages - transplantation; Original Article; Photography; Pilot Projects; Proctology; Rectal Fistula - surgery; Recurrence; Surgery; Transplantation, Autologous - methods; Treatment Outcome; Recurrence; Anal fistula; Autologous cartilage plug
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-015-1299-0

Background The aim of the present study was to assess a novel autologous cartilage plug technique used to treat anal fistula in ten patients. Methods All ten patients had undergone at least two prior operations for recurrent fistulas. The plugs were prepared using the patients’ own cartilage, which was obtained from either the nose or the ear, diced into pieces, and wrapped with oxidized regenerated cellulose. During the same session, fistula tracts were curetted using cytology brushes, and then, the cartilage plug was inserted into the tract. Routine postoperative examinations were performed at 2, 4, 8, 12, and 24 weeks after surgery. Magnetic resonance imaging was performed before surgery and at 3 and 6 months postoperatively. Relief of symptoms, radiological healing, recurrence, and continence were evaluated. Results The ten patients included six males and four females, with a median age of 39 years (range 25–70 years) and a median of three previous fistula operations (range 2–7 operations). Nine patients had cryptoglandular abscess, and one patient had Crohn’s disease. The majority of the patients had transsphincteric fistulas with substantial anal sphincter involvement. The cartilage donor site was the nose for one patient and the ear for nine patients. The median follow-up time was 24 months (range 10–32 months). Of the ten patients, nine had fistula treatment without any short-term complications. The fistula failed to heal in one patient. Among the nine patients whose operations were initially successful, two late recurrences were observed. Conclusions The cartilage plug seems to be a promising alternative for anal fistula treatment.