Fibrin Glue Injection in the Treatment of Fistula-in-Ano: A Non-Invasive Alternative Technique

Abstract

The goal of the study was to demonstrate whether injection of commercially available fibrin glue would be effective as an alternative treatment in closing the tract of the fistula-in-ano. Twenty-one patients with anal fistula were included to the study. There were 4 simple, 7 trans-sphincteric, and 10 inter-sphincteric fistulas. Ten of 21 patients had recurrent fistula. Fibrin glue was injected until it seen overflowed from the primary opening which then secured with two or three absorbable suture material. Follow-up visits were scheduled at one week, 1,3,6, and 12 months. All patients were followed-up at least 12 months. A complete healing was achieved in 14 patients in the first injection. Of the recurred seven patients 2 also had complete closure after second attempt; as a result, overall in 16 patients (76.2%) fibrin glue injection was found to be effective. Failure was observed in 5 patients (23.8%). There was no association between fistula types and recurrence; furthermore, the success rate of fibrin sealant was not affected either by sex, or by previous recurrent fistula (p>0.05). Fibrin glue can be used safely in the treatment of anal fistulas, especially in recurrent and difficult cases. We recommend this technique, as a first choice of treatment in the patients with complex fistula and in whom the surgeon suggested the anal functions would be compromised when conventional surgery carried out.