NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
Status In progress
Process IP
ID number 1704
Description Collagen paste for closing an anal fistula is usually done with the patient under general anaesthesia and in the lithotomy position. The fistula tract is de-epithelised and granulation tissue is removed, before being cleaned with dilute hydrogen peroxide followed by saline. A guiding catheter is connected to a syringe containing the paste and the other end is inserted into the external opening of the fistula. The paste is injected into the fistula until it is visible at the internal opening, and then the guiding catheter is slowly withdrawn. The internal opening of the fistula is closed using resorbable stitches. The external opening is partially closed, using resorbable stitches if needed, to allow any inflammatory fluid to drain out without allowing the collagen paste to escape. The paste fills the exact shape of the tract, which is intended to reduce the risk of it being expelled from the body when defaecating. It is a less invasive procedure than traditional surgery and the aim is to allow the fistula to heal whilst preserving sphincter function.

Provisional Schedule

Expected publication 29 May 2019


Key events during the development of the guidance:

Date Update
02 January 2019 - 30 January 2019 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance