BACKGROUND: Approximately 90% of patients with anal fistulas secondary to Crohn’s disease require surgical intervention. An ideal technique that achieves high cure rates with minimal complications and low recurrence has yet to be established. In other medical disciplines, platelet-rich plasma has demonstrated regenerative and healing properties, offering new therapeutic possibilities. OBJECTIVE: This study aimed to evaluate the 5-year healing rate in patients with anal fistulas due to Crohn’s disease following treatment with platelet-rich plasma. DESIGN: This prospective observational study was conducted between 2011 and 2022. Patients with Crohn’s disease and perianal fistulas who met the inclusion criteria were treated with platelet-rich plasma. Follow-up assessments were carried out at 1, 3, 6, 12, 36, and 60 months. SETTINGS: A single tertiary referral center. PATIENTS: Data from eligible patients with Crohn´s disease-associated anal fistulas were analyzed. MAIN OUTCOME MEASURES: Primary outcomes included fistula healing and recurrence rates, continence status, and complications. RESULTS: A total of 42 patients (45.2% male, 54.8% female; mean age 38.6 ± 11.9 years) were included. 97.6% were receiving active treatment for Crohn´s disease. All procedures were performed on an outpatient basis. Transsphincteric fistulas accounted for 80.9% of cases, 95.2% of which were recurrent. The median time to recurrence was 55±8 months (95% CI: 38–72). Follow-up was completed by 40, 24, and 19 patients at 1, 3, and 5 years, respectively. Mild complications occurred in 23.8% of patients, and continence was preserved, except for one patient. Kaplan–Meier analysis revealed recurrence free-healing of 83.5% at 1 year, 52.5% at 3 years, and 43.8% at 5 years. LIMITATIONS: Include its single-center design and the predominance of transsphincteric fistulas among the cases. CONCLUSIONS: Platelet-rich plasma treatment for anal fistulas in Crohn´s disease patients is safe, feasible in an outpatient setting, and associated with high healing rates and low recurrence. (See Video Abstract )
Díaz et al. (Thu,) studied this question.