Regenerative fistula treatment with platelet-rich fibrin glue as a treatment for complex anal fistulae: a 3-year experience in a tertiary centre

Abstract Introduction Treatment of complex anal fistulae remains a significant challenge. Regenerative fistula treatment (RFT) with platelet-rich fibrin glue (Obsidian®) is one of the available sphincter-preserving techniques. This study aims to evaluate the efficacy of Obsidian® RFT in treating complex anal fistulae based on three years of clinical experience. Method This retrospective study analyzed data from 2019 to 2022, including patients diagnosed with complex anal fistulae who were treated with Obsidian® RFT at the Pelvic Floor Centre in Malmö. Result A total of 213 patients were included in the study: 181 with cryptoglandular fistulae and 32 with Crohn’s disease-associated fistulae. The healing rate, defined as closure of the external opening without any leakage after a single procedure was 31%, increasing to 43% following a second intervention, with a median follow-up of 6.6 months (range 0.5-67.1 months). No statistically significant differences were observed between cryptoglandular and Crohn’s disease-associated fistulae or fistula localization. No serious complications were reported. Cavities and secondary tracts, separately or in combination, were identified as predictors of treatment failure, although only secondary tracts appeared to benefit from Obsidian® RFT in the form of closure or reduction. Discussion Obsidian® RFT achieves moderately good results in the treatment of cryptoglandular and Crohn’s disease-associated fistulae. While secondary tracts can be obliterated or reduced with Obsidian® RFT, further research is needed to improve the management of fistulae associated with cavities.