Advertisement

Diseases of the Colon & Rectum

, Volume 46, Issue 4, pp 498–502 | Cite as

Fibrin Glue for Anal Fistulas

Long-Term Results
  • Stephen M. Sentovich
Article

Abstract

PURPOSE: The aim of this study was to evaluate the long-term success and complication rate of fibrin-glue treatment of anal fistulas. METHODS: Patients with an anal fistula presenting to a single surgeon over a three-year period were enrolled in this study. At their first operation, all 48 patients (26–72 years old) underwent anoscopy, biopsy, destruction of the internal gland, and placement of a draining seton. Approximately two months later after preoperative bowel preparation, the seton was removed, the internal opening closed with a single suture, and fibrin glue instilled by way of the external opening to seal the fistula tract. Patients were followed closely to document the results of treatment and any complications. Long-term follow-up was done by telephone interview. RESULTS: Cause of the anal fistula was cryptoglandular in 36 (75 percent) patients, Crohn’s disease in 5 (10 percent), and miscellaneous in 7 (15 percent). Median follow-up was 22 months (range, 6–46 months). After a single treatment with fibrin glue, 29 (60 percent) fistulas closed. Retreatment with fibrin glue brought the successful number of fistula tracts closed to 33 (69 percent). The 15 (29 percent) patients who failed either one or two treatments with fibrin glue were successfully treated with either fistulotomy or advancement flap. Bowel function and fecal incontinence were not altered by the fibrin-glue treatment. In one patient who failed fibrin glue, the fibrin-glue treatment may have created a more complicated fistula tract. Late recurrences (>6 months) occurred in three (6 percent) patients, two of whom were successfully retreated with fibrin glue. CONCLUSIONS: Fibrin-glue treatment of anal fistulas is successful in up to 69 percent of patients if initial failures are retreated. This sphincter-saving technique is associated with minimal complications and no functional detriment. Late recurrences are unusual.

Keywords

Fibrin glue Anal fistula Crohn’s disease Fistulotomy Endorectal advancement flap 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hjortrup, A, Moesgaard, F, Kjaergard, J 1991Fibrin adhesive in the treatment of perineal fistulasDis Colon Rectum34752754Google Scholar
  2. 2.
    Sentovich, SM 2001Fibrin glue for all anal fistulasJ Gastrointestinal Surg5158161Google Scholar
  3. 3.
    Abel, ME, Chiu, YS, Russell, TR, Volpe, PA 1993Autologous fibrin glue in the treatment of rectovaginal and complex fistulasDis Colon Rectum36447449Google Scholar
  4. 4.
    Venkatesh, KS, Ramanujam, P 1999Fibrin glue application in the treatment of recurrent anorectal fistulasDis Colon Rectum4211361139Google Scholar
  5. 5.
    Patrlj, L, Kocman, B, Martinac, M,  et al. 2000Fibrin glue-antibiotic mixture in the treatment of anal fistulaeDig Surg177780Google Scholar
  6. 6.
    Cintron, JR, Park, JJ, Orsay, CP,  et al. 2000Repair of fistulas-in-ano using fibrin adhesiveDis Colon Rectum43944950Google Scholar
  7. 7.
    Lunniss, PJ, Kamm, MA, Phillips, RK 1994Factors affecting continence after surgery for anal fistulaBr J Surg8113821385Google Scholar
  8. 8.
    Kennedy, HL, Zegarra, JP 1990Fistulotomy without external sphincter division for high anal fistulaBr J Surg77898901Google Scholar
  9. 9.
    Thompson, JP, Ross, AH 1989Can the external sphincter be preserved in the treatment of transsphincteric fistula-in-anoInt J Colorect Dis4247250Google Scholar
  10. 10.
    Parks, AG, Stitz, RW 1976The treatment of high fistula-in-anoDis Colon Rectum19487499Google Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2003

Authors and Affiliations

  • Stephen M. Sentovich

There are no affiliations available

Personalised recommendations