Anal fistulas treatment with bulking agents: An observational study

BACKGROUND: Anal fistulae represent one of the most challenging conditions to treat by proctologists. Nowadays different treatment options are available. METHODS: We analysed our initial experience with bulking agents: we treated 46 patients from January 2014 to December 2017. For our prospective study, they were operated by the same surgical colo-rectal staff in our Istitution. All the details of the procedure were discussed with patients before surgery and a written consent was obtained. All patients were examined after a week, one month, six months and one year after procedure with clinical study including digital examination, proctoscopy and anal UltraSound Scan. We also did a mini-review regarding the most important bulking agents. RESULTS: None of the patients developed continence impairment after procedure. No mortality was observed. Patients needed analgesics for pain relief, for a period of 3-7 days, were 29 of 46 (63%). A total recurrence rate of 21% and overall success rate of 65.2% at 1 year follow-up. CONCLUSIONS: Anal fistulas treatment is still controversial and recurrence is typically very frequent. Our results underlined the importance of an accurate tailored treatment of fistula patients. A unique treatment useful for all types of fistulas does not exist. Among the most recent techniques, bulking agents' injections can be considered simple and safe therapeutic options, with no continence impairment.