Treatment of chronic fistula-in-ano using commercial fibrin glue

OBJECTIVE: To ascertain the effectiveness of commercially available fibrin glue in closing fistulae in ano.

METHODS: A prospective nonrandomized trial was performed on 19 patients admitted to King Khalid University Hospital (KKUH), Riyadh, Kingdom of Saudi Arabia during the period December 2000 to November 2001. Two of the patients had multiple fistulae making a total of 21 fistulae. Patients were prepared preoperatively and managed postoperatively according to a preplanned protocol. The fistulae were injected with fibrin glue after curettage. Follow-up visits were scheduled for one week, one month, 3 months, and one year later.

RESULTS: Nineteen patients received fibrin glue injections for their 21 fistulae in ano. Three patients were lost to follow up. Fourteen out of 18 (78%) fistulae had successful closure. Two of 4 unsuccessful patients reported symptomatic improvement in terms of decreased secretions, itching and pain. There has been no evidence of incontinence or complications related to the use of fibrin glue in this procedure.

CONCLUSION: A healing rate of 78% of chronic fistula-in-ano by treatment with commercial fibrin glue is promising. However, it needs substantiation by increasing the number of patients and prolonging the follow up duration. This procedure is easy for the surgeon to learn and perform. The procedure avoids complications associated with fistulotomy both for the patient and the surgeon.