VM34 - The Use of Viable Cryopreserved Placental Tissue (Stravix) in the Management of a Chronic Fistula in Ano

Purpose/Background: Fistulizing perianal Crohn’s disease presents a unique and challenging condition to manage due to risks of incontinence and high recurrence rates; patients can often be resistant to multiple treatment modalities. This has led to the development of new biosynthetic tools and stem cell therapies to improve surgical outcomes. Stravix is a placental graft designed to preserve the native components of human placental membrane including mesenchymal stem cells, extracellular matrix, growth factors and viable cells such as fibroblasts and epithelial cells; these can suppress inflammation and promote healing. Due to the known properties of human placental tissue and the published success of their use in chronic wounds, its use and management in fistula in ano is being increasingly explored.

Methods/Interventions: A 38-year-old female with a diagnosis of Crohn’s and complex perianal fistula disease initially presented in 2016 with recurrent perianal abscesses. Following drainage, she underwent investigations including MRI, which demonstrated a transphincteric fistula originating in the left lateral position. She was optimized with medical therapy for her Crohn’s disease and proceeded to undergo closure of her fistula tract with overlying Stravix mesh and rectal advancement flap.

Results/Outcomes: Her operative technique was described as follows: (1) examination under anesthesia of the rectum with identification of internal and external openings; (2) coring out of the external component of the fistula tract and debridement of the tract; (3) creation of the mucosal advancement flap, here the mucosa was carefully lifted up using electrocautery in order to create sufficient length for a tension-free advancement flap; (4) debridement and closure of the internal opening; (5) placement of Stravix mesh over the closed internal opening site, which was sutured in place (6) advancement of the mucosal flap over the Stravix graft, the mucosa was re-opposed using interrupted sutures. The patient recovered well and was discharged home the same day.

Conclusion/Discussion: This case demonstrates the use of viable cryopreserved placental tissue in a sphincter-sparing surgery to promote fistula healing in a patient with Crohn’s disease. Human placental tissue presents a promising treatment option for patients with complex perianal disease; there is huge scope for future research into its use in the management of complex perianal fistula disease.