Porcine dermal collagen mesh (Permacol™) as a bioprosthesis in the ligation of intersphincteric tract (BioLIFT) procedure

• Published in: Techniques in coloproctology 2020-12, Vol.24 (12), p.1277-1283
• Main Authors: Tsang, J. S., Chan, T. Y., Cheung, H. H., Wei, R., Foo, C. C., Lo, O. S. H.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Anal Canal; Animals; Bioprosthesis; Collagen; Colorectal Surgery; Fistula; Gastroenterology; Humans; Ligation; Medicine; Medicine & Public Health; Original Article; Proctology; Prospective Studies; Rectal Fistula; Recurrence; Retrospective Studies; Surgery; Surgical Mesh; Swine; Treatment Outcome
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-020-02325-3

Background Ligation of intersphincteric tract (LIFT) is a sphincter-saving technique used to treat anal fistulas. Incorporation of a bioprosthesis in LIFT (BioLIFT) aims to improve healing. The use of cross-linked porcine dermal collagen mesh Permacol™ in BioLIFT has never been investigated. The aim of this study was to compare the healing rates and outcome of LIFT and BioLIFT for complex anal fistulas using the Permacol™ biological mesh. Methods A retrospective analysis of all patients having LIFT or BioLIFT for complex fistulas from January 2010 to November 2019 was performed in a tertiary referral centre. Patient data from a prospectively collected database of all patients having LIFT or BioLIFT were analyzed. Results LIFT and BioLIFT were performed in 48 (82.8%) and 10 (17.2%) patients, respectively. All BioLIFT patients had previous interventions for their fistulas compared to 30 (62.5%) of patients who had LIFT, p  = 0.023. The primary healing rate for LIFT was 87.5% (42/48) compared to 80% (8/10) in BioLIFT, ( p  = 0.42). Eight (13.8%) patients developed complications, 6 (12.5%) in the LIFT group vs 2 (20%) in the BioLIFT group ( p  = 0.62). On univariate analysis, the number of previous operations was predictive of complications ( p  = 0.03). BioLIFT was not associated with complication (OR = 1.75, 95% CI: 0.30–10.3, p  = 0.54) or primary healing (OR = 0.57, 95% CI: 0.97–3.36, p  = 0.54). There was no significant difference in recurrence (LIFT 12.5% vs BioLIFT 0%, p  = 0.58). Kaplan–Meier analysis found no difference in time to recurrence between the two groups ( p  = 0.65). Conclusion Permacol™ mesh in BioLIFT is feasible and achieves a high primary healing rate of 80%. Prospective evidence is needed to establish the benefits of BioLIFT and determine whether Permacol™ is superior to the non-cross-linked porcine submucosal mesh.