UNC doctor develops innovative tissue regeneration approach for abdominal fistula repair

Dr. Joseph Stavas, Vice Chair of Radiology in the UNC School of Medicine, has developed an innovative catheter-based approach for abdominal fistula repair that uses an extracellular collagen matrix material derived from pig intestines.

June 30, 2008

UNC doctor develops innovative tissue regeneration approach for abdominal fistula repair

For years, Becky Brown of Dudley, N.C. has been battling Crohn’s disease. As a result, one problem she has had to deal with several times is the development of an abdominal fistula.

A fistula is an abnormal tunnel or hole that connects two surfaces of the body. Abdominal and anal fistulas are formed when an abscess inside the body bursts and the fluid inside the abscess drains, creating a new channel from the digestive tract to the surface of the skin.

Brown, who is 56 years old and works as a hairdresser in Goldsboro, N.C., has had fistula repair surgery 5 times. Last summer, she had two separate fistulae above her belly button repaired at UNC Hospitals with an innovative, non-surgical approach developed by Dr. Joseph Stavas, Vice Chair of Radiology.

Stavas used a cathether to thread an extracellular collagen matrix material derived from pig intestines into Brown’s fistulae. Once in place, the material – a Cook Surgisis Biodesign fistula plug – prompted tissue regeneration in the affected area.

After her surgeries, Brown said, her recovery time was six weeks. But after the Stavas procedure, “I was back at work the next day,” she said.

Now, one year later, the holes above her belly button that Stavas repaired remain closed. “It’s just as smooth a piece of skin as you can imagine,” Brown said.

Stavas notes that patients with conditions such as inflammatory bowel disease, diverticulitis, colitis, cancer and particularly Crohn’s disease can be at risk for developing an abdominal fistula.

“For the patient a fistula is a very unpleasant problem to have, one that can persist for years and can be very difficult for doctors to cure,” Stavas said.

One effective new method for treating this problem, Stavas said, is to place bioengineered tissue into the fistula.

“The Surgisis plug is an extracellular collagen matrix material that is made from one specific, very thin layer from the inside of a pig intestine, that has been sterilized and prepared for use in human patients,” Stavas said. “When this material is placed inside a fistula, it acts as a scaffold that enables the patient’s body to generate new tissue, which then closes the hole and allows the patient to heal.”

“By using this advanced tissue repair material here at UNC, we have seen patients who had abdominal fistulae that lasted for years heal within 6 to 8 weeks,” he said.

The Surgisis material is manufactured by Cook Biotech Inc., which makes a surgical plug designed specifically for anal fistula repair. UNC’s Dr. Mark Koruda, Chief of Gastrointestinal Surgery, whom Stavas collaborates with, performs anal fistula repair with the Surgisis Biodesign anal fistula plug.

Stavas uses the same product for abdominal fistula repair, but the approach he has developed for putting the material in place is unusual. An Interventional Radiologist by training, Stavas uses catheter-based techniques that are normally used for procedures such as heart catheterizations or for removing blood clots from the brain to snake the plug through complex abdominal anatomy until it reaches its intended destination in the intestine. In addition, in some cases he sews two or more matrix plugs together to customize the repair of unusually long and complicated fistulae.

“This is exciting news,” said Cook Biotech’s President and CEO, Mark Bleyer. “Because Dr. Stavas’ technique eliminates implanting the plug in a traditional surgical procedure, the risk to the patient may actually be decreased. A chronic draining fistula is indeed a very unpleasant problem for a patient. Our Surgisis Biodesign material is designed to enable the patient’s body to generate new tissue and form a permanent repair. However, the specific implantation technique Dr. Stavas describes is truly a new approach. We are delighted that his catheter-based technique has proven successful.”

Persons who would like to be evaluated as potential candidates for the Stavas procedure at UNC Health Care may call 919-843-3208 to schedule an appointment.

Media contact: Tom Hughes, 919-966-6047, tahughes@unch.unc.edu

The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. UNC Health Care is comprised of UNC Hospitals, which is ranked among the top 50 in the nation in six specialties by U.S. News & World Report and ranked one of the country’s 41 best on the Leapfrog 2007 Top Hospitals list; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; and Rex Healthcare and its provider network in Wake County. UNC Health Care also manages Chatham Hospital in Siler City.

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