Repair of fistulas-in-ano using autologous fibrin tissue adhesive

PURPOSE: Our goal was to determine if autologous fibrin tissue adhesive der ived from the precipitation of fibrinogen using a combination of ethanol an d freezing, could be used to completely close both simple and complex fistu las-in-ano. METHODS: A 26-patient pilot study was performed in which 100 ml of a patient's blood was drawn 90 minutes before surgery. Autologous fibri n tissue adhesive was prepared. In the operating room the patient underwent an examination under anesthesia, and the primary and secondary fistula tra ct openings were attempted to be identified. The fistula tract was curetted , and autologous fibrin tissue adhesive was injected into the secondary fis tula tract opening until fibrin glue was seen coming from the primary openi ng. A petroleum jelly gauze was then applied over the secondary opening, an d the patient was sent home. Follow-up visits were scheduled for one week, one month, three months, and one year later. RESULTS: Twenty-six patients r eceived autologous fibrin tissue adhesive fistula injections, with a mean f ollow-up of 3.5 months. Initial results were encouraging. Twenty-one of 26 patients (81 percent) had successful initial closure of their fistulas. Two of five failures were injected a second time, and one closed, giving an ov erall successful closure rate of 85 percent (22/26 patients). Of five patie nts who failed, mean time to failure was 3.8 weeks. In addition, there was no evidence of infection or complications related to the procedure. CONCLUS ION: Our initial results are optimistic and require further support through longer follow-up data. Fibrin glue treatment of anorectal fistulas offers a unique mode of management that is safe, simple, and easy for the surgeon to perform. By using autologous fibrin tissue adhesive the patient avoids t he risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.