Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up

Fibrin adhesive has been successfully used to treat fistulas-in-ano, but long-term data have been lacking. We report the results of our 18-month study examining the repair of fistulas-in-ano using autologous and commercial fibrin adhesive.

A 79-patient, prospective, non-randomized clinical trial was performed in which fibrin adhesive was used to repair fistulas-in-ano. Twenty-six patients were treated with autologous fibrin tissue adhesive made from their own blood, and 53 patients were treated with commercial fibrin sealant. In the operating room the patient underwent an examination under anesthesia, with an attempt to identify the primary and secondary fistula tract openings. The fistula tract was then curetted. Fibrin adhesive was injected into the secondary fistula tract opening until adhesive was seen coming from the primary opening. A petroleum jelly gauze was then applied over both the primary and secondary openings, and the patient was sent home. Follow-up visits occurred one week, one month, three months, and one year later.

Fourteen of 26 (54 percent) patients treated with autologous fibrin tissue adhesive made from their own blood had complete closure of their fistulas after a one-year follow-up, whereas 34 of 53 (64 percent) patients treated with commercial fibrin sealant had closure of their fistulas. Most treatment failures occurred within the first 3 months, but late failures were seen as far as 11 months postoperative.

Fibrin tissue adhesive offers a unique mode of managing fistulas-in-ano, which is surgically less invasive, but recurrences up to one year later are being seen. Longer follow-up and further research is recommended for improvement.