Method for Management of Perianal Fistula with New Device: Progressive Curettage of the Tract and Sealing with Platelet-Rich Fibrin

Javier Perez Lara, Francisco; Ferrer Berges, Arminda; Manuel Hernandez Gonzalez, Jose; Sanchis Cardenas, Elena; Del Rey Moreno, Arturo; Oliva Munoz, Horacio

Method for Management of Perianal Fistula with New Device: Progressive Curettage of the Tract and Sealing with Platelet-Rich Fibrin

Document Type : Brief Report

Authors

Francisco Javier Perez Lara

Arminda Ferrer Berges

Jose Manuel Hernandez Gonzalez

Elena Sanchis Cardenas

Arturo del Rey Moreno

Horacio Oliva Munoz

Digestive Surgery Department, Antequera Hospital, Malaga, Spain

Abstract

Surgical treatment of high perianal fistulas, which affect a significant proportion of the sphincter apparatus, is difficult and associated
with considerable risk of impaired anal continence. The diversity of approaches proposed for the treatment of complex
perianal fistulas reflects the fact that no method has yet been shown to be fully satisfactory. We believe the successful treatment
of this condition is directly proportional to the amount of fibrous tissue that can be removed. We used a kit of small curettes, of
different thicknesses and sizes, incorporating spicules that enable the physician to remove fibrous tissue from the fistula tract. The
small size and varying thicknesses of the curettes enable them to mold to the curves of the fistula tract and to remove tissue by
de-roofing from the shallowest to the deepest layers, thus excising the entire fibrous tract. The tract is then sealed using autologous
fibrin, applied through a catheter, with the help of a monitor indicating the amount of product remaining at all times. Finally, the
internal orifice is closed by simple suturing.

Keywords

Anal Fistula

Sealant

Curettage

Platelet Rich Fibrin