Autologous PRP Shows Promise for Complex Anal Fistulas : Dis Colon Rectum | May 2026

Introduction

Management of complex Anal Fistula remains challenging because durable fistula closure must be balanced against preservation of anal sphincter function. Conventional fistulotomy is often unsuitable in complex disease because of the risk of postoperative fecal incontinence, prompting increasing interest in minimally destructive sphincter-preserving therapies. Platelet-Rich Plasma has emerged as a biologically active regenerative strategy with potential to promote fistula healing while minimizing tissue injury.

Problem Statement

Current sphincter-preserving procedures for complex anal fistulas often demonstrate variable healing rates, technical complexity or substantial recurrence risk. Evidence supporting standalone autologous platelet-rich plasma therapy without adjunctive surgical closure techniques has remained limited, particularly in large heterogeneous real-world cohorts.

Summary

This retrospective Swedish referral-center study evaluated 90 consecutive patients with complex anal fistulas treated using a staged autologous platelet-rich plasma protocol. Patients underwent detailed preoperative evaluation with endoanal three-dimensional ultrasonography, which fully replaced pelvic MRI within the treatment pathway. Initial examination under anesthesia with seton placement was followed by delayed fistula occlusion using autologous PRP after approximately three months.

Clinical and ultrasonographic healing was achieved in 63% of patients after a single PRP closure procedure. Repeat minimally invasive treatments further improved outcomes, with an additional 11% healing after a second procedure and another 7% after a third intervention, resulting in an overall closure rate exceeding 80% following repeated therapy. Importantly, no postoperative anal incontinence or procedural complications were reported, emphasizing the sphincter-preserving safety profile of the approach.

The study included a broad spectrum of fistula types and patient demographics without major exclusion criteria, supporting potential generalizability to complex real-world practice. Statistical analysis suggested that patient age was not a significant determinant of healing outcome. The authors also highlighted the practical advantages of the technique, noting its relative technical simplicity, low tissue destructiveness and repeatability compared with more invasive reconstructive procedures.

Although limited by its retrospective single-surgeon design and absence of a control group, the study provides encouraging evidence supporting autologous PRP as a safe and potentially effective minimally invasive treatment option for complex anal fistulas. The findings further reinforce growing interest in biologically regenerative sphincter-preserving therapies within colorectal surgery and suggest that repeat PRP application may substantially improve cumulative fistula healing rates without compromising continence.