Fibrin glue in the management of complex anal fistula.
BACKGROUND
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.
Damin
Daniel C
DC
Division of Coloproctology, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil. damin@terra.com.br
Rosito
Mário A
MA
Contu
Paulo C
PC
Tarta
Cláudio
C
D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012003:Rectal Fistula / Q000628:therapy*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D017211:Treatment Failure; D055815:Young Adult
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives