PLACENTA DERIVED TISSUE GRAFTS ARE A FEASIBLE ADJUNCT TO THE REPAIR OF RECALCITRANT RECTOVAGINAL FISTULA
Leonardo C. Duraes, Alyssa Parian, Florin Selaru, Susan Gearhart*
Surgery, Johns Hopkins Medical Institutions, Towson, MD
Background
Fistulizing perianal disease is a debilitating disease and a challenging condition to treat. Recently, the use of stem cells has been explored as a method to improve healing of fistulae through release of trophic factors to generate new tissue growth. We utilized a placental derived stem cell graft implanted into fistula repairs for recalcitrant rectovaginal and rectourethral fistula to examine healing rates.
Methods
Patients with recalcitrant rectovaginal (RV) or rectourethral (RU) fistula were consented to participate in this study. Repair types was based upon surgeon’s choice and StravixÒ Smith-Nephew cryopreserved placental tissue graft was incorporated as in in-lay using a previously reported technique (Ann R Coll Surg Engl. 2017 Nov;99:e236-e240). Demographic data including history of prior repairs, radiation, and Inflammatory Bowel Disease (IBD). All patients were seen for a minimum of 6 weeks. Healing was defined as no drainage or presence of a fistula on exam.
Results
From 9/2017-9/2019, 16 patients underwent 18 repairs (17 RV fistula, 1 RU fistula). The median age was 49 (range 31 – 81), one male was included, the mean number of previous repairs was 2, the most common repair was an overlapping sphincteroplasty (62.5%), and the median follow up was 25 (4 – 104) weeks. 3 (6%) patients had a history of radiation and 5 (31%) had IBD of which 2 had pouch-vaginal fistulas. The overall healing rate was 8 (50%) patients and 2 underwent a second repair. No patient had an adverse reaction. In addition, healing rates were best for patients with less than 2 prior repairs (5/9, 62.5%), IBD (3/5, 60%), and surgery with a rectal advancement flap (4/7, 57%).
Conclusion
Cryopreserved placental tissue is a safe adjunct to the repair of RV fistula and may have some efficacy in promoting fistula healing. Futures studies incorporating different fistula type and repair techniques are warranted.
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