Fístula Anorretal Recidivada: Desfechos Comparativos entre Fistulotomia, Retalho Mucoso de Avanço e Fibrina Rica em Plaquetas Injetável em Estudo Clínico Prospectivo
Recurrent Anorectal Fistula: Comparative Outcomes of Fistulotomy, Mucosal Advancement Flap, and Injectable Platelet-Rich Fibrin in a Prospective Study
Ana Luiza Moraes Rocha; Gabriella Giandotti Gomar; Dayara Mussi Salomão; Henrique Luckow Invitti; Maria Lourdes Pessole Biondo Simões
Resumo
Palavras-chave
Abstract
Introdução: As fístulas anorretais recidivadas apresentam elevadas taxas de recidiva e risco de comprometimento funcional, tornando desafiadora a escolha da técnica cirúrgica que proporcione adequada cicatrização com preservação da continência anal.
Métodos: Estudo clínico prospectivo comparativo, incluindo 27 pacientes com fístula anorretal recidivada submetidos à fistulotomia (n=8), fibrina rica em plaquetas (PRF) injetável (n=12) ou retalho mucoso de avanço (n=7). Foram avaliadas cicatrização, recidiva, complicações, dor pós-operatória, uso de opioides e qualidade de vida aos 15, 60, 90 e 180 dias.
Resultados: As taxa de cura clínica foram de 85,7% no grupo retalho mucoso de avanço, 75,0% na fistulotomia e 66,7% no PRF, sem diferença estatisticamente significativa (p=0,098). A incontinência fecal ocorreu exclusivamente no grupo fistulotomia (37,5%). A dor pós-operatória e a necessidade de opioides foram significativamente maiores na fistulotomia em comparação ao PRF (p=0,003 e p=0,045). Observou-se tendência de melhora da qualidade de vida nos grupos PRF e retalho mucoso de avanço (p=0,069), enquanto a recidiva foi mais frequente no grupo PRF (33,3%).
Conclusão: O retalho mucoso de avanço apresentou o melhor equilíbrio entre cicatrização e preservação funcional. A fistulotomia esteve associada à maior morbidade, especialmente pela ocorrência de incontinência fecal, enquanto o PRF injetável mostrou perfil de segurança favorável, porém menor eficácia quando utilizado em aplicação única.
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Referências
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Submetido em:
16/07/2026
Aceito em:
21/08/2026
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