Purpose
Both flap repair and fibrin glue are accepted sphincter-preserving techniques for managing anal fistulas. Additionally, the two techniques are not mutually exclusive and can be combined. This trial was undertaken to determine whether the combination of flap repair and fibrin glue resulted in better outcomes than flap repair alone.
Methods
Between July 2000 and March 2004, patients with transsphincteric anal fistulas were randomly assigned to advancement flap repair alone or flap repair combined with fibrin glue obliteration of the fistula tract. Data regarding age, gender, fistula anatomy, race, and previous repairs were collected. Fistulas managed by fistulotomy or caused by Crohn’s disease, acute obstetric trauma, or radiation were excluded from this study.
Results
There were 58 patients randomized to flap repair alone or flap repair with fibrin glue (47 males; median age, 47 (range, 29–68) years). Mucosal advancement flap was performed in 36 patients and anodermal advancement flap was performed in 22. The median follow-up was 22 (range, 12–36) months. Total fistula recurrence rate for all patients was 32.6 percent. The recurrence rate for fistulas repaired by advancement flap alone was 20 percent, whereas the recurrence rate for fistulas repaired by advancement flap with fibrin glue was 46.4 percent (P < ;0.05).
Conclusions
The data fail to show improved outcomes when fibrin sealant is used in combination with an advancement flap compared with advancement flap alone for the management of complex anal fistulas.
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References
J Garcia-Aguilar C Belmonte WD Wong SM Goldberg R Madoff (1996) ArticleTitleAnal fistula surgery: factors associated with recurrence and incontinence Dis Colon Rectum 39 723–729 Occurrence Handle8674361 Occurrence Handle1:STN:280:BymB1M%2FlsFM%3D Occurrence Handle10.1007/BF02054434
JG Williams CA MacLeod DA Rothenberger SM Goldberg (1991) ArticleTitleSeton treatment of high anal fistulae Br J Surg 78 1159–1161 Occurrence Handle1958973 Occurrence Handle1:STN:280:By2D28bltlU%3D
JS McCourtney IG Finlay (1995) ArticleTitleSetons in the surgical management of fistula in ano Br J Surg 82 448–452 Occurrence Handle7613885 Occurrence Handle1:STN:280:ByqA3sfmtF0%3D
JK Hamaleinen AP Sainio (1997) ArticleTitleCutting setons for anal fistulas: high risk of minor control defects Dis Colon Rectum 40 1443–1447 Occurrence Handle10.1007/BF02070710
JR Cintron JJ Park CP Orsay et al. (2000) ArticleTitleRepair of fistulas-in-ano using fibrin adhesive Dis Colon Rectum 43 944–950 Occurrence Handle10910240 Occurrence Handle1:STN:280:DC%2BD3czmsFKisg%3D%3D Occurrence Handle10.1007/BF02237355
SM Sentovich (2001) ArticleTitleFibrin glue for all anal fistulas J Gastrointest Surg 5 158–161 Occurrence Handle11331478 Occurrence Handle1:STN:280:DC%2BD3Mzjt1Cltw%3D%3D Occurrence Handle10.1016/S1091-255X(01)80028-7
M Singer J Cintron R Nelson et al. (2005) ArticleTitleA prospective randomized trial of the repair of fistulas-in-ano using fibrin sealant in combination with intra-adhesive antibiotics and/or surgical closure of the primary fistula opening Dis Colon Rectum 48 799–808 Occurrence Handle15785883 Occurrence Handle10.1007/s10350-004-0898-z
J Loungnarath DW Dietz MG Mutch EH Birnbaum IJ Kodner JW Fleshman (2004) ArticleTitleFibrin glue treatment of complex anal fistulas has a low success rate Dis Colon Rectum 47 432–436 Occurrence Handle14978618 Occurrence Handle10.1007/s10350-003-0076-8
O Zmora N Mizrahi N Rotholtz et al. (2003) ArticleTitleFibrin glue sealing in the treatment of perineal fistulas Dis Colon Rectum 46 584–589 Occurrence Handle12792432 Occurrence Handle10.1007/s10350-004-6612-3
GN Buchanan CI Bartram RK Phillips et al. (2003) ArticleTitleEfficacy of fibrin sealant in the management of complex anal fistula: a prospective trial Dis Colon Rectum 46 1167–1174 Occurrence Handle12972959 Occurrence Handle10.1007/s10350-004-6708-9
JR Cintron JJ Park CP Orsay et al. (2000) ArticleTitleRepair of fistulas-in-ano using fibrin adhesive: long-term follow-up Dis Colon Rectum 43 944–950 Occurrence Handle10910240 Occurrence Handle1:STN:280:DC%2BD3czmsFKisg%3D%3D Occurrence Handle10.1007/BF02237355
I Lindsey MM Smilgin-Humphreys C Cunningham NJ Mortensen BD George (2002) ArticleTitleA randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula Dis Colon Rectum 45 1608–1615 Occurrence Handle12473883 Occurrence Handle10.1007/s10350-004-7247-0
IJ Kodner A Mazor EI Shemesh RD Fry JW Fleshman EH Birnbaum (1993) ArticleTitleEndorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas Surgery 114 682–689 Occurrence Handle8211682 Occurrence Handle1:STN:280:ByuD38vlsFU%3D
N Mizrahi SD Wexner O Zmora et al. (2002) ArticleTitleEndorectal advancement flap: are there predictors of failure? Dis Colon Rectum 45 1616–1621 Occurrence Handle12473884 Occurrence Handle10.1007/s10350-004-7248-z
T Sonoda T Hull MR Piedmonte VW Fazio (2002) ArticleTitleOutcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap Dis Colon Rectum 45 1622–1628 Occurrence Handle12473885 Occurrence Handle10.1007/s10350-004-7249-y
DD Zimmerman JB Delemarre MP Gosselink WC Hop JW Briel WR Schouten (2003) ArticleTitleSmoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas Br J Surg 90 351–354 Occurrence Handle12594672 Occurrence Handle1:STN:280:DC%2BD3s%2Fot1OitQ%3D%3D Occurrence Handle10.1002/bjs.4044
H Ortiz J Marzo (2000) ArticleTitleEndorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas Br J Surg 87 1680–1683 Occurrence Handle11122184 Occurrence Handle1:STN:280:DC%2BD3M%2FnvFeruw%3D%3D Occurrence Handle10.1046/j.1365-2168.2000.01582.x
UM Gustafsson W Graf (2002) ArticleTitleExcision of anal fistula with closure of the internal opening: functional and manometric results Dis Colon Rectum 45 1672–1678 Occurrence Handle12473893 Occurrence Handle10.1007/s10350-004-7257-y
A Pino ParticleDel RL Nelson RK Pearl H Abcarian (1996) ArticleTitleIsland flap anoplasty for treatment of transsphincteric fistula-in-ano Dis Colon Rectum 39 224–226 Occurrence Handle8620792 Occurrence Handle10.1007/BF02068080
EP Cronkite EL Lozner JM Deaver (1944) ArticleTitleUse of thrombin and fibrinogen in skin grafting JAMA 124 976–978
P Kirkegaard PV Madsen (1983) ArticleTitlePerineal sinus after removal of the rectum: occlusion with fibrin adhesive Am J Surg 145 791–794 Occurrence Handle6602560 Occurrence Handle1:STN:280:BiyB38fnsVw%3D Occurrence Handle10.1016/0002-9610(83)90142-3
TM Hammond MF Grahn PJ Lunniss (2004) ArticleTitleFibrin glue in the management of anal fistulae Colorectal Dis 6 308–319 Occurrence Handle15335361 Occurrence Handle1:STN:280:DC%2BD2cvjtVGktg%3D%3D Occurrence Handle10.1111/j.1463-1318.2004.00676.x
SM Sentovich (2003) ArticleTitleFibrin glue for anal fistulas: long-term results Dis Colon Rectum 46 498–502 Occurrence Handle12682544 Occurrence Handle10.1007/s10350-004-6589-y
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.
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Ellis, C.N., Clark, S. Fibrin Glue as an Adjunct to Flap Repair of Anal Fistulas: A Randomized, Controlled Study. Dis Colon Rectum 49, 1736–1740 (2006). https://doi.org/10.1007/s10350-006-0718-8
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DOI: https://doi.org/10.1007/s10350-006-0718-8