Efficacy of synthetic glue treatment of high crypoglandular fistula-in-ano

Abstract

In France, seton drainage followed by fistulotomy is currently the standard treatment for high cryptoglandular fistula-in-ano. Biological or synthetic glues, such as Glubran(®)2, have been recently proposed for sealing the fistula tract. The purpose of this study is to determine the healing rate with glubran2 and to assess the functional outcome after cure of fistula-in-ano. From July 2006 to July 2008, 34patients (20males; median age 48.5years, range 22-55years) with high cryptoglandular anal fistulas were treated with glubran2. Patients were seen for physical examination at 1, 3 and 6months, then interviewed by telephone at 1 and 2years, and in September 2009. The Fecal incontinence severity index (FISI) score was used to assess continence. The healing rate at 1month was 67.6% (23patients); the fistula failed to heal in 11patients. All 23patients with a healed fistula remained recurrence-free, with no continence disorders noted, during the median 34-month follow-up period (range 21-43months). One patient was lost to follow-up after 6months. Glubran2 provides an effective treatment for high fistula-in-ano, with no change in continence. In future, a randomized comparison of this agent with fibrin glues should be useful.