title: Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage?
abstract: OBJECTIVE
  In recent decades, fibrin glue has appeared as an alternative treatment for high perianal fistulas. Early results seemed promising, with high success rates being reported. However, with increasing follow-up, the enthusiasm was tempered because of disappointing results. The aim of this retrospective study was to assess the additional value of fibrin glue in combination with transanal advancement flap, compared to advancement flap alone, for the treatment of high transsphincteric fistulas of cryptoglandular origin.
  
  
  METHODS
  Between January 1995 and January 2006, 127 patients were operated for high perianal fistulas with an advancement flap. After exclusion of patients with inflammatory bowel disease or HIV, 80 patients remained. A consecutive series of 26 patients had an advancement flap combined with obliteration of the fistula tract with fibrin glue. Patients were matched for prior fistula surgery, and the advancement was performed identically in all patients. In the fibrin glue group, glue was installed retrogradely in the fistula tract after the advancement was completed and the fistula tract had been curetted.
  
  
  RESULTS
  Minimal follow-up after surgery was 13 months [median of 67 months (range, 13-127)]. The overall recurrence rate was 26% (n=21). Recurrence rates for advancement flap alone vs the combination with glue were 13% vs 56% (p=0.014) in the group without previous fistula surgery and 23% vs 41% (p=0.216) in the group with previous fistula surgery.
  
  
  CONCLUSIONS
  Obliterating the fistula tract with fibrin glue was associated with worse outcome after rectal advancement flap for high perianal fistulas.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Koperen
authors.forename: Jan
authors.initials: J
authors.lastname: Wind
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: J Frederik M
authors.initials: JF
authors.lastname: Slors
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D013524:Surgical Flaps
chemical_list: D015718:Fibrin Tissue Adhesive