Fibrin glue is a novel treatment for anal fistulas. It possesses many advantages in the treatment of difficult high fistulas.
The treatment with fibrin glue is simple and repeatable, failure does not compromise further treatment options, and, additionally, sphincter function is preserved.
In this study, a team of researchers from England compared the outcomes of patients with low and high anal fistulas.
The team randomly assigned patients to either fibrin glue or conventional treatment.
| Healing of complex fistulas:|
- Fibrin glue = 69%
- Conventional treatment = 13%
|Diseases of the Colon and Rectum|
They excluded patients with rectovaginal fistulas and anal fistulas associated with chronic cavities, acute sepsis, and side branches.
The primary end point was fistula healing.
Secondary end points were complications, changes in preoperative continence score, changes in maximum resting and squeeze pressure, satisfaction scores, and pain scores and time off work (simple fistulas only).
The team found that the patients in both study arms were well matched for gender, median age, duration of fistula symptoms, and follow-up.
They found that fibrin glue healed 50% of simple fistulas, while conventional fistulotomy healed 100%.
They identified no change in baseline incontinence score, maximum resting pressures, or squeeze pressures between the study arms.
Return to work was quicker in the glue arm, but pain scores were similar and satisfaction scores higher in the fistulotomy group.
However, fibrin glue healed 69% of complex fistulas, compared with 13% in the conventional treatment group.
The team found no change in baseline incontinence score, maximum resting pressures, or squeeze pressures in either study arm.
Satisfaction scores were higher in the fibrin glue group.
Dr Ian Lindsey’s team concluded, “No advantage was found for fibrin glue over fistulotomy for simple fistulas, but fibrin glue healed more complex fistulas than conventional treatment and with higher patient satisfaction”.