{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:29:49Z","timestamp":1790839789209,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Injection of Permacol collagen paste can be used as a sphincter\u2010sparing treatment for perianal fistulas. In a tertiary referral population we aimed to evaluate the efficacy of Permacol injection and the clinical and fistula\u2010related factors associated with recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a retrospective analysis of consecutive patients with perianal fistulas treated with Permacol injection at a specialist centre between June 2015 and April 2019. Endoanal ultrasonography was systematically reanalysed, blinded to treatment outcome. Rectovaginal, anovaginal and Crohn's disease fistulas were excluded. Healed fistulas were defined as absent anal symptoms and a closed external opening on physical examination at a minimum follow\u2010up of 6\u00a0months. Regression analyses were performed to identify factors associated with unhealed fistulas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 90 patients (51 men; median age 45\u00a0years) were analysed. Seventy\u2010two (80.0%) patients had complex perianal fistulas (greater than one\u2010third sphincter involvement or multiple tracts). After a single Permacol injection, fistulas were healed in 20 (22.2%) patients at 3\u00a0months follow\u2010up and in 18 (20.0%) patients at a median follow\u2010up of 30\u00a0months (interquartile range 17\u201337). Eight (11.1%) patients with unhealed fistulas had significant improvement in their symptoms. Complex fistulas were significantly associated with unhealed status [OR 3.53 (95% CI 1.12\u201311.09); <jats:italic>p<\/jats:italic>\u00a0=\u00a00.031]. Twenty patients underwent subsequent Permacol injections, which were successful in six (30.0%) patients after one (<jats:italic>n<\/jats:italic>\u00a0=\u00a03) or two (<jats:italic>n<\/jats:italic>\u00a0=\u00a03) additional injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This largest study to date in patients with mainly complex perianal fistulas, demonstrated that the efficacy of a single Permacol injection was only 20%. Complex fistulas were associated with a poor outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.15696","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T21:56:57Z","timestamp":1620338217000},"page":"2119-2126","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Efficacy of Permacol injection for perianal fistulas in a tertiary referral population: poor outcome in patients with complex fistulas"],"prefix":"10.1111","volume":"23","author":[{"given":"Paul F.","family":"Vollebregt","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC Amsterdam Gastroenterology Endocrinology Metabolism Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grietje J.","family":"Vander Mijnsbrugge","sequence":"additional","affiliation":[{"name":"Proctos Kliniek Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte B. H.","family":"Molenaar","sequence":"additional","affiliation":[{"name":"Proctos Kliniek Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richelle J. F.","family":"Felt\u2010Bersma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC Amsterdam Gastroenterology Endocrinology Metabolism Vrije Universiteit Amsterdam Amsterdam The Netherlands"},{"name":"Proctos Kliniek Bilthoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-015-2227-5"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800630102"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1645-5"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14814"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-007-0334-7"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0136"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-019-02051-5"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02070708"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02054531"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02054434"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000352"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5905-2"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15148"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-019-02023-9"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12224"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-017-2779-7"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003981"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-003-0076-8"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13715"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-018-0743-8"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-019-01932-z"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1590-3"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2009.02087.x"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/1553350618808120"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13211"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12046"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640620907570"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-315503"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.15696","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.15696","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.15696","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T19:28:48Z","timestamp":1692300528000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.15696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,16]]},"references-count":28,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1111\/codi.15696"],"URL":"https:\/\/doi.org\/10.1111\/codi.15696","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,16]]},"assertion":[{"value":"2020-12-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}