Limited fistulectomy and fibrin glue for the treatment of complex fistula-in-ano

Background: The study was designed to assess results of a combination of limited fistulectomy and fibrin glue instillation for the treatment of complex fistula-in-ano. Method: All patients who fulfilled the criteria of complex cryptoglandular fistula-in-ano were included in the study. After initial assessment at surgical outpatient clinic (SOPD), patients were admitted for examination under anaesthesia (EUA). Following the assessment of the fistula and its track, fibrin glue instillation was carried out. The fistula track was partially excised and followed by instillation of glue. All the patients were followed up at the SOPD at regular intervals to determine development of recurrence and related morbidities associated with the procedure. Results: Fourteen patients were included in the study with a mean age of 45.6 years and the mean follow up was 13 months. Ten patients (71%) had high transsphincteric fistula. One patient had extrasphincteric fistula and the remaining three patients had multiple fistula tracks. Two (14%) patients had prior seton insertion before fibrin glue instillation due to persistent infection. All patients had successful fistula closure after the initial instillation. However 2(14%) patients had recurrence after 4 and 3 months respectively after the surgery. In our study, healing time ranged from 6 to 12 weeks (mean: 8 weeks) and all patients were free from any morbidities related to surgery. Conclusion: A combination of limited fistulectomy and fibrin glue instillation for complex fistulain-ano appear to be safe, easy and effective.