BIO RAMP: BIOlogic Augmented Repair of Complex Anal Fistula Using Acellular Matrix and/or Autologous Platelet-rich Plasma
Study Details
Study Description
Brief Summary
The purpose of this study is to compare the clinical effectiveness of augmenting surgical repair of complex anal fistula using autologous PRP and/or micronized acellular porcine urinary bladder matrix (UBM) to usual surgical care alone to prevent fistula recurrence or improve HRQoL, to compare the effects of augmenting surgical repair of complex anal fistula using autologous PRP and/or micronized acellular porcine urinary bladder matrix on early postoperative pain and fecal continence and to assess the cost utility of augmented complex fistula repair relative to usual surgical care
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Sham Comparator: Surgery Control patients will receive usual standard of care surgical repair of their complex fistula by The ligation of intersphincteric tract (LIFT) or advancement flap technique without any biologic adjunct. |
Procedure: Surgery
Control patients will receive usual standard of care surgical repair of their complex fistula by LIFT or advancement flap technique without any biologic adjunct.
|
| Experimental: Surgery plus platelet-rich plasma (PRP)
|
Procedure: Surgery
Control patients will receive usual standard of care surgical repair of their complex fistula by LIFT or advancement flap technique without any biologic adjunct.
Other: Platelet-rich plasma (PRP)
Participants will have 40-50cc of peripheral whole blood drawn into a syringe pre-loaded with acid citrate dextrose (ACD) anticoagulant and concentrated PRP harvested by double centrifugation technique using the manufacturer's kit and benchtop centrifuge. This typically yields 5-8cc of PRP that is 18-times more concentrated than baseline.
|
| Experimental: Surgery plus matrix
|
Procedure: Surgery
Control patients will receive usual standard of care surgical repair of their complex fistula by LIFT or advancement flap technique without any biologic adjunct.
Device: Matrix
Participants will receive 200g of "paste" matrix and 200g injected at the following sites: the internal opening closure site at level of the sphincter muscle, within the walls of the fistula tract along its length, and within the tissue of an advancement flap particularly at areas of tissue apposition.
|
| Experimental: Surgery plus PRP plus matrix material
|
Procedure: Surgery
Control patients will receive usual standard of care surgical repair of their complex fistula by LIFT or advancement flap technique without any biologic adjunct.
Other: Platelet-rich plasma (PRP)
Participants will have 40-50cc of peripheral whole blood drawn into a syringe pre-loaded with acid citrate dextrose (ACD) anticoagulant and concentrated PRP harvested by double centrifugation technique using the manufacturer's kit and benchtop centrifuge. This typically yields 5-8cc of PRP that is 18-times more concentrated than baseline.
Device: Matrix
Participants will receive 200g of "paste" matrix and 200g injected at the following sites: the internal opening closure site at level of the sphincter muscle, within the walls of the fistula tract along its length, and within the tissue of an advancement flap particularly at areas of tissue apposition.
|
Outcome Measures
Primary Outcome Measures
- Number of participants with fistula recurrence [upto 6 months after surgery]
A fistula recurrence is defined as one or more of the following clinical signs or symptoms after repair: recurrent abscess at the site of repair, chronic drainage or passage of flatus from an external opening of the perineum away from the anal verge, a non-healing external opening that tracks toward anus by probing with fistula probe.
- Change in Health-related quality of life (HRQoL) as assessed by the EQ-5D-5L questionnaire [Baseline, 1week post surgery, 2 weeks post surgery, 6 weeks post surgery, 3 months post surgery, 6 months post surgery, and 12 months post surgery.]
This instrument queries subjects on health status related to mobility, self-care, 'usual' activities, pain/discomfort, and anxiety/depression with 5 potential responses ranging from "no problems" to inability to complete the task or extreme levels of pain/depression, correlating to a discrete index score from 1-5, a higher number indicating a worse outcome.The instrument also includes an overall VAS self-rating of health ranging from 0-100, higher number indicating better health.
Secondary Outcome Measures
- Number of participants who have post operative pain as assessed by the visual analog scale (VAS) [14 days after surgery]
This is scored from 0-100, higher number indicating better health
- Change in fecal continence as assessed by the Cleveland Clinic Fecal Incontinence (CCFI) scoring tool [Baseline, 2 weeks after surgery,6 weeks after surgery,3 months after surgery,6 months after surgery and 12 months after surgery]
This is a 5 item questionnaire that assesses type of incontinence (solid, liquid, gas, wears pad, lifestyle alteration). The frequency with which each type of incontinence occurs is rated on a scale from 0 (never) to 4 (always or to 1/day). The sum of the frequencies is added to yield a total score that can range from 0 to 20, with higher scores indicating higher levels of incontinence.
- The relative cost utility of the different treatment strategies as assessed by a questionnaire [12 months after surgery]
A cost effectiveness analysis (CEA) will be done from the healthcare system perspective assessed as the incremental health system costs (or savings) per fistula recurrence prevented
Eligibility Criteria
Criteria
Inclusion Criteria:
-
complex cryptoglandular transsphincteric anal fistula undergoing surgical repair by LIFT or advancement flap procedure
-
English or Spanish speaking and capable of providing informed consent
-
Willing to undergo temporary anal seton drainage for requisite time prior to repair
-
Participating surgeons will only be eligible if they perform at least 3 repair procedures/year
Exclusion Criteria:
-
Unable to reliably complete follow up for 12 months postoperatively
-
Primary platelet disorders
-
Thrombocytopenia < 150 plt/microliter
-
Inability to stop anti-platelet agent > 5 days preoperatively
-
Fistula associated with inflammatory bowel disease (IBD), malignancy or pelvic/perineal radiation
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | The University of Texas Health Science Center at Houston | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- The University of Texas Health Science Center, Houston
- CENTER FOR CLINICAL AND TRANSLATIONAL SCIENCES
Investigators
- Principal Investigator: Jeffrey L Van Eps, MD, The University of Texas Health Science Center, Houston
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HSC-MS-22-0759