Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases

Abstract

Background/Aims: To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. Materials and Methods: This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts ≤3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. Results: After a follow-up of 18–36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a ≤3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). Conclusion: The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract ≤3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.

The Role of Fibrin Glue in the Treatment of High and Low Fistulas in Ano

“…It had been suggested in the past, that suturing of the internal opening prevented the expulsion of the clot, but various recent trials [10][11][12][13][14][15] have proved that there was no significant change in the healing rate, with this procedure. Nine out of these 10 recurrences (90%), were reported in the first 3 months of the follow up.…”

Treatment of Fistulas in ano with Fibrin Glue

“…Their success rate was 74% after 1–3 instillations. Patrlj et al[ 19] used the same principle of decontaminating the fistulas with antibiotics, and furthermore they used a fibrin glue-antibiotic mixture in their definite treatment. Success rates of 74% were reported.…”

“…Many advantages have been described using fibrin glue in the treatment of anal fistulas. It is simple, repeatable, with minor surgical trauma so sphincter function is preserved and further surgical treatment is not compromised [12,13,14,15,16,17,18,19,20,21,22,23]. Recent publications show promising results using this technique.…”

“…Reported results are not univocal in their treatment protocols. A great variety of techniques has been described, such as placement of a draining seton before fibrin glue closure and the use of fibrin glue-antibiotic mixtures [19,20,21]. Also there is a great variation in success rates of different fistula types.…”

Autologous bone marrow derived stem cells in the treatment of complex anal fistula

“…It reached as low as 14%. 17,18 The evolving role of stem cells in medical practice allowed multiple studies to use mesenchymal stem cells with variable study designs. In all of the studies conducted till now, surgery was combined with cell application as a single-step procedure, with or without fibrin glue reaching the healing rate of 50%-90% for fistulae.…”