title: Long-term results of surgery plus fibrin sealant for anal fistula.
abstract: OBJECTIVE
  The long-term recurrence rate of fibrin glue treatment was analysed in patients with trans-sphincteric cryptoglandular fistula operated by a two-phase procedure: (i) fistulectomy with seton placement; (ii) fibrin sealant (Tissucol Duo®, Baxter) insertion in the track.
  
  
  METHODS
  Clinical data were collected prospectively for all patients operated between 2004 and 2010. The statistical association of clinical variables and recurrence was analysed and a disease-free curve was constructed using the Kaplan-Meier method.
  
  
  RESULTS
  Twenty-eight consecutive patients (mean age 48.3 ± 13.3 years; 22 men) were enrolled in the study. Middle and high trans-sphincteric fistulae were diagnosed in 20 (71.4%) and eight (28.6%) patients. Seven (25%) had secondary track formation. The mean interval between the first operation and the fibrin sealant treatment was 12.5 ± 7.6 months. There were no complications related to the procedure. Nine (32.1%, 95% CI 17.9-50.7%) patients developed recurrence between 3 and 27 months after fibrin sealant treatment. Disease-free curves showed that the highest probability of recurrence occurred in the first 2 years. No incontinence was found at a mean follow-up of 20.6 (3-60) months among the 67.8% patients with no evidence of recurrence.
  
  
  CONCLUSIONS
  Fibrin sealant is safe and simple. The healing rate is satisfactory without the risk of incontinence.
authors.affiliation: Department of Surgery, Colorectal Unit, Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: de Oca
authors.forename: M
authors.initials: M
authors.lastname: Millán
authors.forename: A
authors.initials: A
authors.lastname: Jiménez
authors.forename: T
authors.initials: T
authors.lastname: Golda
authors.forename: S
authors.initials: S
authors.lastname: Biondo
mesh_terms: D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012003:Rectal Fistula / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D015718:Fibrin Tissue Adhesive