AB120. SOH25_AB_267. A systematic review comparing laser closure versus platelet-rich plasma injection in Crohn’s perianal fistulas

Background: Perianal fistulas relating to Crohn’s disease affect approximately one third of all Crohn’s disease patients. This debilitating condition impacts many aspects of a patient’s life. Traditional surgical techniques carry significant risks to the anal sphincter with complications like major faecal incontinence. Newly developed minimally invasive surgeries aim to reduce this risk. Laser closure and platelet-rich plasma injection are two modern techniques used to generate healing for perianal fistulas.

Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used to select relevant studies. We included nine laser closure studies and four platelet-rich plasma studies. The primary outcome assessed was complete healing of the fistula tract. Secondary outcomes looked at variations related to patient profiles, and post-operative complications.

Results: The complete healing rate for laser closure was 59% (n=126). The complete healing rate for platelet-rich plasma injection was 52.5% (n=59). Only two studies split patient profiles by healing status, so patient profiles were listed without indication of specific healing status. Post-operative complications included pain, minor soiling, gas incontinence, abscess, and bleeding.

Conclusions: Healing outcomes between laser closure and platelet-rich plasma were not statistically significant (P=0.431). A key finding was the lack of major post-operative incontinence following these minimally invasive surgeries. This is important due to the risk of anal sphincter injury in some traditional perianal fistula treatment options. Further studies are required to fully assess patient demographics.

Keywords: Crohn’s; perianal; fistula; laser; platelet-rich