P0708Comparative Outcomes of Barbed Suture for Internal Opening Closure in Anal Fistulas: A Study of Crohn’s Disease Versus Cryptoglandular Etiologies

Background Anal fistulas, especially complex perianal fistulizing Crohn’s disease (pfCD), present a considerable therapeutic challenge. The barbed suture technique for closing internal orifice may improve healing by ensuring secure, tension-free approximation. This study aimed to assess the clinical and radiological outcomes of this technique in patients with pfCD and cryptoglandular anal fistulas. Methods A retrospective cohort study was conducted involving patients who underwent barbed suture closure of the internal orifice between January 1, 2022, and October 1, 2024. Patients were assessed using the Fistula Drainage Assessment (FDA) at the 3-month follow-up. Postoperative radiological outcomes were assessed by magnetic resonance imaging (MRI) within 12 months and categorized as healing, improvement, no change, or deterioration. The Perianal Crohn’s Disease Activity Index (PDAI) and the MAGNIFI-CD score were used to assess pfCD patients pre- and postoperatively. Fistula recurrence was defined as the reappearance of a fistula at its original anatomical site. Results The cohort included 62 patients with pfCD (34 with complex fistulas) and 23 with cryptoglandular fistulas (7 complex). Clinical healing was achieved in 47 patients (75.8%) of pfCD patients and 20 (87.0%) of cryptoglandular fistula patients. The PDAI decreased significantly from 7 (IQR: 6-11) at baseline to 3 (IQR: 0-5) (P < 0.001) in pfCD patients. A numerical difference was observed, with higher clinical healing in the cryptoglandular fistula group compared to pfCD patients, but it was not statistically significant (χ² = 1.29, P = 0.256). Follow-up MRI within one year was available for 10 patients with cryptoglandular anal fistulas, demonstrating complete healing in 8 patients (80%) and improvement in 2 patients (20%). Among the 30 pfCD patients, radiological healing was observed in 10 (33.3%), improvement in 14 (46.7%), no change in 4 (13.3%), and deterioration in 2 (6.7%). The MAGNIFI-CD Score decreased significantly from 13 (IQR: 8-17) at baseline to 10 (IQR: 2-14) (P = 0.001). The overall recurrence rate was 21.3% over a median follow-up period of 8 months. Kaplan-Meier analysis revealed significantly lower recurrence-free survival rates in pfCD patients (p < 0.05). Multivariate analysis identified the non-use of biologic agents (OR = 3.5, 95% CI: 1.5-8.0, p < 0.01) and complex fistula anatomy (OR = 4.0, 95% CI: 1.8-9.0, p < 0.001) as independent predictors of non-healing in pfCD patients. Conclusion The barbed suture technique for closing internal orifice demonstrates acceptable clinical and radiological efficacy. MRI-based assessment confirms its effectiveness in promoting structural repair in pfCD patients. Conflict of interest: Liu, Xiaoyu: No conflict of interest Gu, Yunfei: No conflict of interest Yan, Yuehua: No conflict of interest Yi, Jiaqin: No conflict of interest Luo, Dongmei: No conflict of interest Wang, Hao: No conflict of interest