The Use of Biological ‘Infill’ Materials for the Treatment of Recto/Ano-vaginal Fistulae-A Systematic Review

Abstract

Aim: recto-vaginal fistulas are rare but distressing. They are most commonly caused by obstetric injury, a failed pelvic anastomosis, or Crohn's Disease. Biological infill materials have been used in their management. We assessed the efficacy of biological infill materials when treating Crohn's and non-Crohn's related recto-vaginal fistulas. Method: We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twenty-five articles were A pooled total of 105 patients underwent infill treatments; 27% had Crohn's. Fifty-six percent of patients had treatment with glue, 31% plug, 6% permacol paste and 7% stem cells. Within the Crohn's group, the majority underwent treatment with glue (50%), 39% with an anal fistula plug and 11% stem cells. Overall healing rate was 41%; highest was for stem cells (71%) and lowest (32%) for glue. Within the Crohn's population, healing rates were 36%, glue having the lowest healing rate (14%), followed by the anal fistula plug (55%). Stem cells had a healing rate of 67%. Conclusion: Overall, the use of infill materials to treat Crohn's and non-Crohn's related recto-vaginal fistulas is associated with healing in approximately forty one percent of cases. Crohn's related recto-vaginal fistulas represent a more challenging group of patients to treat.