{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:07:34Z","timestamp":1790827654177,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complex perineal fistulas frequently recur after surgery. Hyperbaric oxygen therapy (HBOT) augments tissue oxygenation and may enhance healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective matched cohort study, we reviewed 53 consecutive patients who received HBOT during repair of perianal, rectovaginal, or pouch\u2010vaginal fistulas (2012\u20132024). Each was matched 1:3 to controls treated without HBOT by age, sex, body mass index, and fistula type. Demographics, operative history, healing, recurrence and stoma reversal were compared. Healing was defined as complete clinical closure confirmed at examination. Kaplan\u2010Meier (KM) curves assessed time\u2010to\u2010fistula recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HBOT patients had longer median fistula duration than controls (2.7 vs. 1.5\u2009years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), higher diversion rates (89% vs. 47%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and were more likely to have undergone more than two prior surgeries (70% vs. 34%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). At 6\u2009months follow\u2010up, 45 (84.9%) patients in the HBOT group achieved fistula healing compared with 122 (76.3%) patients in the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.18). After a median follow\u2010up of 1.4 and 2.7\u2009years for HBOT and non\u2010HBOT groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.55), respectively, 4 (9%) HBOT patients and 20 (16.4%) controls developed fistula recurrence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.38). The Kaplan\u2013Meier estimated recurrence\u2010free survival of healed fistulas was numerically higher with HBOT at 6, 12 and 18\u2009months: 83%, 78% and 74% versus 75%, 68% and 65% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.20). After stoma reversal, recurrence was lower with HBOT 5.9% versus 26.5% (log rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035). Among patients with three or more repairs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200990), healing at last follow\u2010up was 85% after HBOT versus 66% in controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HBOT was associated with lower recurrence after stoma reversal and with more durable healing in fistulas that had already failed multiple prior repairs, without changing stoma reversal rates. These data suggest that HBOT may be a useful adjunct in the reconstructive strategy for complex recurrent perineal fistulas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70398","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:49:39Z","timestamp":1772970579000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of hyperbaric oxygen therapy on complex perineal fistula healing"],"prefix":"10.1111","volume":"28","author":[{"given":"Awwab F.","family":"Hammad","sequence":"first","affiliation":[{"name":"Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metincan","family":"Erkaya","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute Cleveland Clinic  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