The Use of Biological ‘Infill’ Materials for the Treatment of Recto/Ano-vaginal Fistulae-A Systematic Review

Aim: Recto-vaginal fistulae are distressing. They are most commonly caused by obstetric injury, a failed pelvic anastomosis, or Crohn’s disease. Biological infill materials have been used in their management. We assessed the efficacy of biological infill materials when recto-vaginal fistulae. Methods: We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twenty-five articles yielded a pooled total of 105 patients; 27% had Crohn’s disease. Fifty-six percent of patients had treatment with glue, 31% with plug, 6% with permacol paste and 7% with stem-cells. For Crohn’s, 50% were treated with glue, 39% with a fistula plug and 11% with stem cells. The overall healing rate for all infill materials was 41%, with the highest reported rate amongst the stem cell group (71%) and the lowest (32%) for glue. For Crohn's, the overall healing rate was 36%, glue was the lowest (14%), followed by the anal fistula plug (55%). Stem cells had a healing rate of 67%. Conclusions: Overall, the use of infill materials to treat Crohn’s and non-Crohn’s related recto-vaginal fistulae is associated with healing in approximately 41% of cases. Crohn’s related recto-vaginal fistulae represent a more challenging group of patients to treat.