Fibrin glue treatment for simple and complex anal fistulas.

BACKGROUND/AIMS: Surgical management of anal fistulas is associated with considerable morbidity, mainly related to anal sphincter injury. However, treatment with fibrin glue is a safe and simple method associated with less discomfort and complications. A prospective trial was conducted at our institute to evaluate the use of fibrin glue (Tissucol, Baxter, The Netherlands) for simple and complex anal fistulas.

METHODOLOGY

From November 2001 until March 2004, 34 patients (22 male, 12 female, median age 40 years) were treated with Tissucol. Twenty-three (67%) fistulas were classified as simple (subcutaneous, intersphincteric and transsphincteric) and 11 (33%) as complex (suprasphincteric, extrasphincteric and/or associated with Crohn's disease, ulcerative colitis or HIV).

RESULTS

Twenty-six patients were treated once, 5 patients were treated twice, 2 patients were treated 3 times and 1 patient underwent 4 Tissucol treatments. After a median follow-up of 7 months, 13 of 23 simple fistulas (56%) and 6 out of 11 complex fistulas (54%) healed, accounting for an overall closure rate of 55%. Complications occurred in two patients, who both developed a perineal abscess after glue instillation.

CONCLUSIONS

Fibrin glue treatment is safe and effective in 55% of the patients with anal fistulas. It is a good alternative to conventional surgery.