A team of physicians from England performed a prospective trial to evaluate the long-term healing of complex idiopathic anorectal fistula after fibrin glue treatment
They used both clinical assessment and magnetic resonance imaging to determine tract healing.
The doctors assessed 22 patients, who underwent glue instillation after fistula curettage and irrigation. Patients were followed up for a median of 14 months.
The team performed clinical assessment, short tau inversion recovery sequence MRI, and combined short tau inversion recovery and dynamic contrast-enhanced MRI, a median of 3 months postoperatively. They determined their ability to predict outcome in the presence of early skin healing.
Of 22 patients, 87% had transsphincteric fistulas, 5% had a suprasphincteric fistula, 5% had an extrasphincteric fistula, and 5% had a rectovaginal fistula.
No patients had evidence of secondary extension.
|Only 14% remained healed at 16 months.|
|Diseases of the Colon and Rectum|
The researchers found that, despite skin healing in 77% a median of 14 days after treatment, only 14% remained healed at 16 months.
They determined that MRI with short tau inversion recovery sequences, in combination with dynamic contrast-enhanced magnetic resonance imaging, predicted outcome in 100% of assessments. This compared to 94% for short tau inversion recovery sequence alone, and 71% for clinical examination.
Dr Gordon Buchanan's team concluded, "The success rate of fibrin glue application for complex anorectal fistulas without extension is 14%".
"Magnetic resonance imaging predicts outcome at an earlier stage than clinical examination".