Fibrin glue in perianal fistulas--a pilot study

Anal fistula surgery is associated with considerable morbidity, mainly related to anal incontinence. As promising results of the use of fibrin glue in the treatment of complex anal fistulas were recently shown, we planned to do a randomized trial comparing the use of fibrin glue and surgery in the treatment of perianal fistulas. There were no reports of the use of fibrin glue in the management of previously untreated anal fistulas.

Prior to the planned study a pretrial pilot series of 10 patients with different perianal fistulas were treated. Informed consent was obtained from every patient. Under spinal anesthesia, the fistula track was identified and brushed to remove granulous tissue, then washed with hydrogen peroxide and thereafter filled with fibrin glue.

We performed fibrin gluing on 10 patients with perianal fistulas of different etiology and type. The gluing was done once to 7 patients, twice to 2 and three times to one patient. In all but one patient the fistula and symptoms recurred after only one month. One patient with a low trans-sphincteric fistula of which the internal opening was not found, was symptom-free for 6 months. At the one-month follow-up visit the external opening of the fistula was almost unidentifiable, suggesting that the fistula had healed. However, due to recurrence fistulotomy was performed after 6 months.

Fistulas around the anus, with or without associated inflammatory bowel disease, do not seem to heal after fibrin gluing.