Fibrin glue in the management of complex anal fistula

Abstract

-Context -Management of complex anal fistulas is associated with the risk of sphincter injury and fecal incontinence.In recent years, fibrin glue has emerged as an alternative sphincter-preserving treatment for anal fistulas. To date, however, there is no consensus about the efficacy of the method. Objective -To specifically evaluate the fibrin glue injection in the management of complex cryptoglandular anal fistulas. Methods -We studied a series of patients with complex anal fistulas treated with fibrin glue between January 2005 and January 2007. Only patients with fistulas of cryptoglandular origin were analyzed. Patients with fistulas related to Crohn's disease, HIV or previous surgery were excluded from the study. Under spinal anesthesia, the fistulas were curetted and injected with fibrin glue. After treatment, patients were followed-up for 12 months. Results -Thirty-two patients were enrolled in the study. Two patients were lost to follow-up and were excluded. Out of the remaining 30 patients, only three healed successfully (10%). Among the 27 patients who failed to heal, 9 (33.3%) were diagnosed within the first postoperative month. In 13 patients (48.1%) the failure of treatment occurred in the period between 1 and 3 months, in 3 patients (11.1%) between 3 and 6 months, and in 2 patients (7.4%) between 6 and 9 months after surgery. No treatment-related complications were observed. Conclusions -In this series, fibrin glue treatment for complex cryptoglandular anal fistulas achieved a very low healing rate. Our results do not support the use of fibrin glue as a first-line treatment for patients with this type of fistula. HEADINGS -Rectal fistula. Fibrin tissue adhesive. Tissue adhesives.

Using autologous platelet-rich plasma for the treatment of complex fistulas

“…Various therapies have been suggested over time (fibrin, plugs, etc. ), but results are controversial (5,6).…”

“…Most studies usually include few patients, different assessment methods, and inappropriate methodologies (5,6).…”

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

“…Although advances in surgery and technology have led to various ''minimally invasive'' approaches [1,2], results in terms of success rate and recurrence are quite disappointing. The failure rate is approximately 30-60 % for established surgical procedures such as the endorectal advancement flap (ERAF) [3,4] and injection of biological glues [5,6]. Also the initial enthusiasm for even newer techniques, such as anal fistula plug [7,8] and ligation of the intersphincteric fistula tract (LIFT) [9,10], decreased at the long-term follow-up, with a recurrence rate of about 70-80 % and 30-60 %, respectively [11][12][13][14][15].…”

Fístula Anorrectal: ¿son Las Técnicas Nuevas Superiores a Las Clásicas?

“…Aunque los estudios iniciales de este procedimiento fueron promisorios, los resultados a mediano y largo plazo son desalentadores, con persistencia o recurrencia del 31 al 90% (Tabla 5) [34][35][36][37][38][39][40][41][42] . La aplicación de un sellante de fibrina con la técnica de colgajo mostró un descenso en la recidiva de 46% a 20% en un estudio 43 , mientras que la falla global alcanzó al 88% en otro estudio similar 44 .…”