[Biological fibrin used in anal fistulas: 31 patients].
OBJECTIVE
The different treatments proposed for transsphincteric and suprasphincteric cryptoglandular anal fistulas are often complex and often associated with complications. After one or two stage anal fistulotomy, the risk of change in fecal continence ranks from 30% to 40%. This rate is lower (10%) with transanal advancement flap repair technique. A new therapeutic approach (fistula track closure by means of a fibrin sealant) that we have developed in our study allows to avoid classical sphincter dissection or section which could jeopardize normal sphincter function.


METHODS
Over a 20 month period, 31 consecutive patients (mean age: 42; 24 males and seven females) with transsphincteric (n = 28) or suprasphincteric (n = 3) anal fistula have been included in this study and treated with injection of a fibrin sealant into fistula track. Patients were controlled during a mean follow-up of 9 month.


RESULTS
Fistula cure was obtained in 83.9% cases (75% after single fibrin sealant application). Success was achieved after a second application in two patients. Neither change in fecal continence nor other complication was observed during application and during follow-up period.


CONCLUSIONS
This technique is simple (100% feasibility) and is reproductible. Results are comparable with "classical" techniques. However, despite this surgical procedure which could be seen as simple, it requires a throrough methodology.
Jurczak
F
F
Service de chirurgie viscérale et carcinologique, polyclinique de l'Océan, 38, rue de Pornichet, 44600 Saint-Nazaire, France. chirurgie.psn@wanadoo.fr
Laridon
J Y
JY
Raffaitin
Ph
P
Pousset
J P
JP
D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006490:Hemostatics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D012307:Risk Factors; D013524:Surgical Flaps; D014014:Tissue Adhesives / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014014:Tissue Adhesives