Fibrin glue has been used to treat anal fistulas, however, reported success rates vary.
In this study, physicians from the United States reviewed the use of fibrin glue in the management of complex anal fistulas at a tertiary referral center.
The team collected data on demographics, previous treatment, operative information, and early follow-up from patients' medical records.
They also conducted phone interviews to determine successful healing or recurrence of fistulas requiring further treatment.
|Durable healing occurred in 31%.|
|Diseases of the Colon and Rectum|
The physicians found that a total of 42 patients (19 male, median age 44 years) were treated between 1999 and 2002.
Of these, 3 were lost to follow-up.
The team determined that the etiology of fistulas was cryptoglandular in 22 patients, Crohn's disease in 13, and coloanal and ileal pouch-anal anastomotic in 4.
They classified the fistulas as deep transsphincteric in 33 patients, superficial transsphincteric in 1, supralevator in 2, and rectovaginal in 3.
The physicians determined that most patients had closure of the fistula initially, but recrudescence was common.
Overall, durable healing occurred in 31% of patients.
The team examined healing rates by etiology. The rates were 23% for cryptoglandular fistulas, 31% for Crohn's disease, and 75% for ileal pouch-anal anastomotic.
Success rates by classification were deep transsphincteric 33%, superficial transsphincteric 0%, supralevator 0%, and rectovaginal 33%.
In addition, the team found that the success rate for patients with no previous treatment was 38%, compared with 22% in patients who had previously received treatment.
The team found that 8 patients underwent a second fibrin glue treatment. Only 1 of these healed.
Median follow-up for successfully healed fistula was 26 months.
Dr Rasmy Loungnarath and colleagues concluded, "Fibrin glue treatment for complex anal fistulas has a low success rate and most recrudescences occurred within 3 months".
"However, given the low morbidity and relative simplicity of the procedure, fibrin glue should still be considered as a first-line treatment for patients with complex anal fistulas".