title: Fibrin glue sealing in the treatment of perineal fistulas.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
authors.forename: Nelly
authors.initials: N
authors.lastname: Mizrahi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rotholtz
authors.forename: Alon J
authors.initials: AJ
authors.lastname: Pikarsky
authors.forename: Eric G
authors.initials: EG
authors.lastname: Weiss
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D012003:Rectal Fistula / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives