Abstract
PURPOSE: The surgical management of complex perineal fistulas, such as high transsphincteric and suprasphincteric fistulas, or those associated with Crohn’s disease, radiotherapy, surgical trauma, or cavity or a secondary tract, is associated with the risk of sphincter injury and significant discomfort. Fibrin glue may close fistula tracts without muscle division. Therefore, the aim of this study was to evaluate the use of fibrin glue sealing in treatment of perineal fistulas. METHODS: A retrospective chart review of all patients in whom fibrin glue was used for the treatment of perineal fistula was performed. Patients were contacted by telephone to establish follow-up. RESULTS: Thirty-seven patients underwent injection of fibrin glue for complex perineal fistulas. Twenty-four patients had fibrin glue injection as the principal treatment for the perineal fistula, and 13 had fibrin glue in conjunction with an endorectal advancement flap. The fistula was of cryptoglandular origin in 16 (42 percent) cases and associated with Crohn’s disease and trauma in 7 (19 percent) and 14 (38 percent) patients, respectively. At a mean follow-up of 12.1 months, healing occurred in only 15 (41 percent) patients. The healing rate was 33 percent when fibrin glue was the principal treatment, and 54 percent when used with an endorectal advancement flap. Fistulas of noncryptoglandular origin had a higher success rate, although this difference did not reach statistical significance. There was no morbidity associated with the injection of fibrin glue. CONCLUSION: In this study, fibrin glue had moderate success in the definitive treatment of perineal fistulas. However, 33 percent of the patients in whom fibrin glue was the only treatment used were able to avoid more extensive surgery. Fibrin glue is associated with minimal risk, therefore its application should be considered in patients with complex anal fistulas.
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References
PS Ramanujam ML Prasad H Abcarian AB Tan (1984) ArticleTitlePerianal abscesses and fistulas Dis Colon Rectum 27 593–597
J Garcia-Aguilar C Belmonte DW Wong SM Goldberg RD Madoff (1998) ArticleTitleCutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula Br J Surg 85 243–245
WR Schouten DD Zimmerman JW Briel (1999) ArticleTitleTransanal advancement flap repair of transsphincteric fistulas Dis Colon Rectum 42 1419–1423
GE Romanos JR Strub (1998) ArticleTitleEffect of Tissucol on connective tissue matrix during wound healing J Biomed Mater Res 39 462–468
TL Hwang MF Chen (1996) ArticleTitleRandomized trial of fibrin tissue glue for low output enterocutaneous fistula Br J Surg 83 112–468
C Cellier B Landi A Faye et al. (1996) ArticleTitleUpper gastrointestinal tract fistulae Gastrointest Endosc 44 731–733
N Mizrahi SD Wexner O Zmora et al. (2002) ArticleTitleEndorectal advancement flap Dis Colon Rectum 45 1616–1621
P Aitola KM Hiltunen M Matikainen (1999) ArticleTitleFibrin glue in perianal fistulas—a pilot study Ann Chir Gynaecol 88 136–138
A Hjortrup F Moesgaard J Kjaergard (1991) ArticleTitleFibrin adhesive in the treatment of perineal fistulas Dis Colon Rectum 34 752–754
ME Abel YS Chiu TR Russell PA Volpe (1993) ArticleTitleAutologous fibrin glue in the treatment of rectovaginal and complex fistulas Dis Colon Rectum 36 447–449
KS Venkatesh P Ramanujam (1999) ArticleTitleFibrin glue application in the treatment of recurrent anorectal fistulas Dis Colon Rectum 42 1136–1139
L Patrlj B Kocman M Martinac et al. (2000) ArticleTitleFibrin glue-antibiotic mixture in the treatment of anal fistulae Dig Surg 17 77–80
JR Cintron JJ Park CP Orsay et al. (2000) ArticleTitleRepair of fistulas-in-ano using fibrin adhesive Dis Colon Rectum 43 944–950
JJ Park JR Cintron CP Orsay et al. (2000) ArticleTitleRepair of chronic anorectal fistulae using commercial fibrin sealant Arch Surg 135 166–169
JR Cintron JJ Park CP Orsay RK Pearl RL Nelson H Abcarian (1999) ArticleTitleRepair of fistulas-in-ano using autologous fibrin tissue adhesive Dis Colon Rectum 42 607–613
SM Sentovich (2001) ArticleTitleFibrin glue for all anal fistulas J Gastrointestinal Surg 5 158–161
W Beierlein AM Scheule G Antoniadis C Braun R Schosser (2000) ArticleTitleAn immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant Transfusion 40 302–305
R Berguer RL Staerkel EE Moore FA Moore WB Galloway MB Mockus (1991) ArticleTitleWarning: fatal reaction to the use of fibrin glue in deep hepatic wounds. Case reports J Trauma 31 408–411
LN Milde (1989) ArticleTitleAn anaphylactic reaction to fibrin glue Anesth Analg 69 684–686
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Zmora, O., Mizrahi, N., Rotholtz, N. et al. Fibrin Glue Sealing in the Treatment of Perineal Fistulas. Dis Colon Rectum 46, 584–589 (2003). https://doi.org/10.1007/s10350-004-6612-3
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DOI: https://doi.org/10.1007/s10350-004-6612-3