[Repair of anorectal fistulas using fibrin glue tissue adhesive--preliminary experience in 15 patients].

PURPOSE: The goal of this study was to evaluate whether commercially produced fibrin sealant can be used for the treatment of complex anorectal fistulae. METHODS: Fibrin glue was used for patients with primary and recurrent ano-rectal fistulae, but patients with Crohn's disease or AIDS were excluded. The procedure was performed under anesthesia in the operating room. The primary and secondary openings were identified using blue dye. The secondary opening and the tract of the fistula were curetted, and 4 ml of fibrin sealant were injected through the secondary opening until fibrin sealant was seen coming from the primary opening. The patients were discharged on the next day following the procedure, and were followed-up closely in the outpatient clinic. RESULTS: Fifteen consecutive patients underwent one trial of fibrin glue injections. The average follow-up period was 4 months. Overall, eleven of the 15 patients (73.3%) had successful closure of their fistulae. The healing rates for intersphincteric, transsphincteric and suprasphincteric were 50%, 77.7% and 100% respectively. Fibrin glue treatment was effective in five out of the 6 patients (83.3%) who were operated on for recurrent fistulae. Of the 4 patients in whom the treatment failed, the mean time for recurrent symptoms was 4 weeks. No patient suffered from fecal or gas incontinence and all of the patients returned promptly to routine life. CONCLUSION: Sealing the tracts with fibrin glue is a unique mode for the treatment of ano-rectal fistulae, and our preliminary results with this technique are promising. The procedure is safe and easy to perform, and can be offered as an alternative to conventional surgery. Most importantly, this method minimizes the risk of fecal incontinence and the discomfort of prolonged wound healing.