A PROSPECTIVE STUDY TO EVALUATE THE EFFICACY OF FIBRIN GLUE IN FISTULA-IN-ANO

BACKGROUND AND AIMS: Fistulotomy remains the gold standard for the treatment of both low and high anal fistulae. The invasive nature of this modality and the associated risk of incontinence following fistulotomy have propelled the search for alternatives. We present our results after a 12 month follow-up of the instillation of fibrin glue in both low and high fistulae in ano including complicated cases such as post-surgery recurrence and horseshoe shaped fistulae. MATERIALS AND METHODS: Thirty patients were enrolled in the study as day cases after prior informed consent. This study was cleared by the appropriate ethics committee. Patients underwent a thorough clinical work-up including a digital rectal examination and proctoscopy. An MRI was done in patients with a history of previous fistula surgery or for those in whom the internal opening was not palpable. The fistula tracts were irrigated with saline. Reconstituted fibrin glue was then injected into the fistula using a proprietary injector. Patients were followed up regularly in the outpatient department over the next year. RESULTS: Of the 30 patients, 14 had a low fistula and 16 had a high fistula, with 6 previously operated cases in the latter group. A cumulative success rate of 87.5% (14/16) and 100% (14/14) was noted in the high and low fistulae sub-populations respectively. Five of the six patients with prior fistula surgery also healed completely. CONCLUSIONS: Fibrin glue instillation is an efficacious, minimally invasive and potentially sphincter sparing alternative to surgery with promising results in patients with complex fistulae and post fistula surgery recurrence.