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Prospective, Multicenter Evaluation of Highly Concentrated Fibrin Glue in the Treatment of Complex Cryptogenic Perianal Fistulas

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE

The surgical management of complex perianal fistulas is challenging and may be associated with the risk of sphincter injury. Instillation of fibrin glue to the fistula tract is a simple procedure that does not involve any muscle division, and potentially results in healing of the fistula. This study was designed to assess the use of highly concentrated fibrin glue with intra-adhesive antibiotics in the treatment of complex cryptogenic perianal fistulas.

METHODS

Patients with complex perianal fistulas of cryptogenic origin were prospectively included in this multicenter study. Injection of the fibrin glue mixed with antibiotics was performed in a uniform fashion. After the procedure, patients were actively examined at fixed time intervals; in cases of recurrent fistula, reinjection of fibrin glue was offered.

RESULTS

Sixty patients were enrolled; complete healing of the fistula was achieved in 32 patients (53 percent). Eight of 28 patients (29 percent) who were not completely healed had significant symptomatic improvement. All patients resumed normal daily activity the day after surgery and none had any deterioration in continence related to the procedure. The majority of the 26 (43 percent) adverse events were considered mild and spontaneously resolved; 2 patients (3 percent) with perianal septic complications were successfully treated by drainage.

CONCLUSIONS

Injection of fibrin glue for the treatment of perianal fistulas is safe, simple, and associated with early return to normal activity. Although moderately successful, it may preclude extensive surgery in more than one-half of these patients.

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Authors and Affiliations

  1. Department of Surgery, Sheba Medical Center, Tel Aviv, Israel

    Oded Zmora M.D., Dan Scott M.D., Marat Khaikin M.D. & Moshe Koller M.D.

  2. Department of Surgery, Meir Medical Center, Tel Aviv, Israel

    David Neufeld M.D.

  3. Department of Surgery, Assaf Harofe Medical Center, Tel Aviv, Israel

    Yehiel Ziv M.D. & Albert Stepansky M.D.

  4. Department of Surgery, Tel-Aviv-Sorasky Medical Center and the Sackler School of Medicine, Tel Aviv, Israel

    Hagit Tulchinsky M.D. & Micha Rabau M.D.

Authors
  1. Oded Zmora M.D.
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  2. David Neufeld M.D.
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  3. Yehiel Ziv M.D.
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  4. Hagit Tulchinsky M.D.
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  5. Dan Scott M.D.
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  6. Marat Khaikin M.D.
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  7. Albert Stepansky M.D.
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  8. Micha Rabau M.D.
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  9. Moshe Koller M.D.
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Corresponding author

Correspondence to Oded Zmora M.D..

Additional information

The fibrin glue for this study was supplied by Omrix, Israel. The podium presentation was supported by Omrix, Israel.

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Zmora, O., Neufeld, D., Ziv, Y. et al. Prospective, Multicenter Evaluation of Highly Concentrated Fibrin Glue in the Treatment of Complex Cryptogenic Perianal Fistulas. Dis Colon Rectum 48, 2167–2172 (2005). https://doi.org/10.1007/s10350-005-0199-1

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  • DOI: https://doi.org/10.1007/s10350-005-0199-1

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