Repair of chronic anorectal fistulae using commercial fibrin sealant

Hypothesis: Commercially produced fibrin sealant can be used to completely close both simple and complex fistulae in ano. Methods: A 29-patient prospective nonrandomized clinical trial was performe d. In the operating room, the patient underwent an er;amination with anesth esia and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted and fibrin sealant was injec ted into the secondary fistula tract opening until fibrin sealant was seen coming from the primary opening. A petroleum jelly gauze was then applied o ver the secondary opening and the patient was sent home. Follow-up visits w ere scheduled for 1 week, 1 month, 3 months, and 1 year later. Results: Twenty-nine consecutive patients received fibrin sealant injection s for their fistulae in ano, with a mean follow-up of 6 months. Two patient s had a history of Crohn disease (regional enteritis) and 2 patients had hu man immunodeficiency virus infection. Overall, 17 (68%) of 25 patients have had successful closure of their fistula with 4 patients lost to follow-up. Two patients required reinjection with fibrin sealant, and neither of thes e subsequently had closure. One of the 2 patients with Crohn disease had cl osure, as well as I human immunodeficiency virus-positive patient. In addit ion, there has been no evidence of incontinence or complications related to the use of fibrin sealant in this procedure. Conclusions: Initial results in the treatment of chronic anorectal fistulae using commercial fibrin sealant are optimistic, but require further suppor t through longer follow-up data. Fibrin sealant treatment of anorectal fist ulae offers a unique mode of management which is safe, simple, and easy for the surgeon to perform. By using fibrin sealant, the patient avoids the ri sk of fecal incontinence and the discomfort of prolonged wound healing that may be associated with fistulotomy.