Effectiveness of Combined Mucosal Advancement Flap with Autologous Platelet-Rich Plasma in the Management of Complex Anal Fistula: A Pilot Randomized Controlled Trial | ||
| The Egyptian Journal of Surgery | ||
| Volume 44, Issue 3, July 2025, Pages 925-932 PDF (591.62 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2025.345685.1318 | ||
| Authors | ||
| Hossam Khalaf* ; Waleed Hassan Moustafa Omar; Mahmoud AbdElnaby Metwally; Samy A Elbaz; Mohamed Balata; Ahmed Fadaly Hussein | ||
| Department of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt | ||
| Abstract | ||
| Background: The management of complex anal fistulas often requires advanced techniques, especially when a considerable portion of the anal sphincter is involved. Platelet-rich plasma (PRP) has emerged as a talented adjunctive therapy, enhancing healing rates and reducing recurrence when combined with mucosal advancement flap (MAF) surgery. Patients and Methods: This study evaluated the effectiveness of MAF with and without locally applied PRP in patients with complex anal fistulas. Primary outcomes included healing rate, with secondary outcomes assessing pain, continence, and quality of life (QoL). Results: This pilot randomized-controlled trial involved 82 patients with comparable demographics and fistula characteristics across groups. PRP significantly reduced healing time (4.2 vs. 4.5 weeks, P= 0.0081) and improved postoperative QoL scores at 1, 3, and 6 months. While initial postoperative pain levels were similar, PRP led to complete pain resolution by 3 months (P= 0.0359). Complication and recurrence rates were comparable between groups, with minor wound infections and incontinence resolving in most cases. Conclusion: The findings indicate that locally applied PRP significantly accelerates healing and enhances QoL for patients undergoing MAF for complex anal fistulas. Although recurrence and complication rates were similar, PRP seems to be a safe and effective adjunctive therapy. | ||
| Keywords | ||
| Anal fistula; Autologous platelet-rich plasma; Healing rate; Mucosal advancement flap; Postoperative pain; Quality of life; Recurrence | ||
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