Abstract
BackgroundNew sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates.MethodsWe performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review.ResultsThe healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68), although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08). Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65). Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02).ConclusionIn literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68), and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08). Anyway the limited collected data do not support the use of fibrin glue. Moreover, in our subgroup analysis the use of fibrin glue in combination with intra-adhesive antibiotics does not improve the healing rate (P = 0.65), whereas the anal fistula plug treatment compared to the fibrin glue treatment shows good results (P = 0,02), although the poor number of patients treated does not lead to any statistically evident conclusion. This systematic review underlines the need of new RCTs upon this issue.
Highlights
New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence
Results from analysis Even if it is not statistically relevant, the healing rate is higher in those patients who underwent conventional surgical treatment (Figure 1)
Results from subgroup analysis In Ky's study the healing rate is statistically significant in the patients who underwent the anal fistula plug treatment of fistulas-in ano [22] (Figure 4)
Summary
New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. It depends on an ineffective surgical treatment and on the fistula etiology For these reasons newer sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence, in patients with high risk. Among these approaches the fibrin glue application is standing out because it is a simple and repeatable technique, whose success rate is improved by repeated injections, and does not interfere or compromise subsequent surgical options. More recent studies do not report the same successful use of this technique, showing low healing rates
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
