PMID- 33536119
OWN - NLM
STAT- MEDLINE
DCOM- 20210830
LR  - 20210830
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 170
IP  - 1
DP  - 2021 Jul
TI  - Ligation of intersphincteric fistula tract (LIFT) with or without injection of 
      platelet-rich plasma (PRP) in management of high trans-sphincteric 
      fistula-in-ano: Short-term outcomes of a prospective, randomized trial.
PG  - 61-66
LID - S0039-6060(20)30888-6 [pii]
LID - 10.1016/j.surg.2020.12.025 [doi]
AB  - BACKGROUND: Success rate after ligation of the inter-sphincteric fistula tract 
      ranges from 40% to 75%. Platelet-rich plasma is hypothesized to improve healing 
      by slowly releasing growth factors. The objective of the study was to compare the 
      efficacy and outcome of ligation of the inter-sphincteric fistula tract plus 
      platelet-rich plasma local injection versus ligation of the inter-sphincteric 
      fistula tract alone in the management of high trans-sphincteric anal fistula in 
      regards to postoperative pain, time for healing, morbidity, fistula closure rate, 
      recurrence, and quality of life. METHODS: This was a prospective randomized 
      trial. Patients with trans-sphincteric anal fistulas involving >50% of anal 
      sphincters were included. Patients were randomly assigned to either ligation of 
      the inter-sphincteric fistula tract plus platelet-rich plasma or ligation of the 
      inter-sphincteric fistula tract (49 in each group). The primary endpoints were 
      successful complete fistula closure and duration needed for healing. Secondary 
      endpoints were morbidity, recurrence after 1 year of follow-up, postoperative 
      pain, and quality of life. RESULTS: Complete primary healing was recorded in 42 
      patients in the ligation of the inter-sphincteric fistula tract plus 
      platelet-rich plasma group and 32 patients in the ligation of the 
      inter-sphincteric fistula tract group, and the difference was statistically 
      significant (P = .03). The mean time to complete healing after ligation of the 
      inter-sphincteric fistula tract plus platelet-rich plasma was significantly 
      shorter than after ligation of the inter-sphincteric fistula tract alone (15.7 +/- 
      4 days vs 21.6 +/- 5.4 days; P = .03). One year after complete healing of anal 
      fistula, recurrence was recorded in 4/42 patients in the ligation of the 
      inter-sphincteric fistula tract plus platelet-rich plasma group and 3/32 patients 
      in the ligation of the inter-sphincteric fistula tract group with no 
      statistically significant difference (P = .99). Patients in the ligation of the 
      inter-sphincteric fistula tract plus platelet-rich plasma group had significantly 
      lower pain scores after both 1 and 7 days. Quality of life and level of happiness 
      were significantly better 1 month after ligation of the inter-sphincteric fistula 
      tract plus platelet-rich plasma. CONCLUSION: Ligation of the inter-sphincteric 
      fistula tract plus platelet-rich plasma for the treatment of high 
      trans-sphincteric fistula-in-ano is a safe modality with significantly higher 
      successful healing rate, shorter healing time, and less postoperative pain 
      compared with ligation of the inter-sphincteric fistula tract alone. Ligation of 
      the inter-sphincteric fistula tract plus platelet-rich plasma does not improve 
      the rate of recurrence; however, it results in significantly higher short-term 
      quality of life.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Madbouly, Khaled M
AU  - Madbouly KM
AD  - Department of Surgery, Section of Colon and Rectal Surgery, University of 
      Alexandria, Egypt. Electronic address: khaled.madbouly@alexmed.edu.eg.
FAU - Emile, Sameh Hany
AU  - Emile SH
AD  - Department of Surgery, Unit of Colon and Rectal Surgery, University of Mansoura, 
      Egypt.
FAU - Issa, Yasmine Amr
AU  - Issa YA
AD  - Department of Medical Biochemistry, University of Alexandria, Egypt.
FAU - Omar, Waleed
AU  - Omar W
AD  - Department of Surgery, Unit of Colon and Rectal Surgery, University of Mansoura, 
      Egypt.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20210131
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Adult
MH  - Anal Canal/*surgery
MH  - Female
MH  - Humans
MH  - Ligation/adverse effects
MH  - Male
MH  - Middle Aged
MH  - *Platelet-Rich Plasma
MH  - Prospective Studies
MH  - Quality of Life
MH  - Rectal Fistula/diagnosis/etiology/surgery/*therapy
MH  - Recurrence
MH  - Treatment Outcome
MH  - Wound Healing
EDAT- 2021/02/05 06:00
MHDA- 2021/08/31 06:00
CRDT- 2021/02/04 05:33
PHST- 2020/10/19 00:00 [received]
PHST- 2020/12/16 00:00 [revised]
PHST- 2020/12/18 00:00 [accepted]
PHST- 2021/02/05 06:00 [pubmed]
PHST- 2021/08/31 06:00 [medline]
PHST- 2021/02/04 05:33 [entrez]
AID - S0039-6060(20)30888-6 [pii]
AID - 10.1016/j.surg.2020.12.025 [doi]
PST - ppublish
SO  - Surgery. 2021 Jul;170(1):61-66. doi: 10.1016/j.surg.2020.12.025. Epub 2021 Jan 
      31.