Role of cyanoacrylate in the management of low fistula in ano: a prospective study

Abstract

Fistulotomy has remained the gold standard in the management of fistula in ano, especially low fistula in ano. Although highly effective in the management of fistula in ano, fistulotomy is associated with considerable discomfort and incontinence. This study was designed to evaluate the role of cyanoacrylate in the management of low fistula in ano. We present our short-term results with a 6-month follow-up. Twenty patients were enrolled in the study as day cases. Patients were analyzed clinically and then subjected to trans-anal ultrasound, as diagnosis of internal opening was not palpable on per rectal examination. The fistula tracks were probed and washed with saline, and granulation tissue at external opening was debrided. The glue was then injected into the fistulous track from a syringe nozzle through an infant feeding tube. Patients were further examined in the outpatient department until 6 months. Seventeen patients got healed with primary injection with stoppage of any discharge from the fistulous track. The other two patients required one more injection and showed no signs of discharge thereafter. One patient who had two external openings continued to discharge from one opening even after two injections. Cyanoacrylate glue can be offered as an effective alternative to surgery in patients suffering from fistula in ano as it is easy, safe, non-invasive, and effective.