Efficacy of Platelet-Rich Plasma in the Treatment of Anal Fistula – A Prospective Study

Abstract

Background: Anal fistula is a chronic condition characterized by an abnormal communication between the anal canal and perianal skin, often resulting in persistent discharge, pain, and frequent recurrences. Conventional treatment approaches, including fistulotomy and seton placement, are associated with prolonged healing time and risks of postoperative complications such as incontinence. In recent years, platelet-rich plasma (PRP) has gained attention as a biological therapy due to its ability to enhance tissue regeneration and wound healing. PRP contains concentrated growth factors that stimulate fibroblast proliferation, angiogenesis, and extracellular matrix remodeling, potentially facilitating fistula closure with improved postoperative outcomes.

Objective: This study aims to evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of anal fistula, assessing its impact on healing rates, time to complete epithelialization, postoperative pain reduction, and recurrence rates in comparison to conventional surgical methods.

Methods: A prospective study was conducted on 100 patients diagnosed with low and high transsphincteric anal fistula at a tertiary care hospital. Participants were randomly allocated into two groups: the PRP-treated group (n=50), where PRP was injected into the fistula tract following debridement, and the control group (n=50), which underwent standard surgical management without PRP. Patients with secondary anal fistula due to Crohn’s disease, tuberculosis, or malignancy were excluded. The primary outcome measures included fistula healing rates, time to complete epithelialization, postoperative pain scores, and recurrence rates, evaluated over a follow-up period of six months. Statistical analysis was performed using SPSS software, with a p-value < 0.05 considered statistically significant.

Results: The mean age of participants was 41.6 ± 12.4 years, with a male predominance of 68 percent. The healing rate in the PRP group was significantly higher at 84.0 percent compared to 60.0 percent in the control group (p = 0.010). Patients treated with PRP experienced faster wound closure, with a mean healing time of 5.9 ± 1.7 weeks versus 8.5 ± 2.4 weeks in the control group (p < 0.001). Postoperative pain scores, assessed using the Visual Analogue Scale (VAS), were lower in the PRP group at one week postoperatively (3.2 ± 1.1) compared to the control group (5.6 ± 1.4, p = 0.015). Recurrence was observed in 16.0 percent of PRP-treated patients versus 34.0 percent in the control group (p = 0.038). No significant complications, including fecal incontinence or severe infections, were reported in either group.

Conclusion: The findings suggest that platelet-rich plasma (PRP) is an effective adjunct therapy in the treatment of anal fistula, significantly enhancing healing rates, reducing postoperative pain, and lowering recurrence compared to conventional surgical methods. Given its autologous nature, minimal invasiveness, and regenerative properties, PRP may serve as a promising alternative in the management of anal fistula. Further large-scale randomized controlled trials are recommended to establish PRP as a standard treatment option.