Fibrin glue-antibiotic mixture in the treatment of anal fistulae: Experience with 69 cases

Background/Aims: To investigate the potential value of the use of the fibri n glue-antibiotic mixture in the treatment of anal fistulae. Materials and Methods: This study included 69 patients with idiopathic nonspecific anal f istulae. Patients with IBD (inflammatory bower disease), TBC, actinomycosis , and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt abo ut vertical classification of the fistulous tract MR of anal canal was nece ssary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fi stulous tract, 24 fistulas had tracts less than or equal to 3.5 cm long, an d 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the ravage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulat ion of the fistulous tract with a special probe for the eradication of gran ulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immu no Ltd., Vienna, Austria) was applied. Results: After a follow-up of 18-36 months (median 28) 18 patients (26%) had a recurrence; among these, intersp hincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%), Regarding the length of the fistulous tract, a fistula with a les s than or equal to 3.5 cm long tract recurred in 13 patients (54%) and a fi stula with a >3.5 cm long tract in 5 (11%). Conclusion: The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibi otic mixture was independent of the vertical disposition of the fistula, an d was dependent on the length of the fistulous tract. Surgical treatment re mains a golden standard for simple fistulae with a tract less than or equal to 3.5 cm. Anal fistulae with a longer tract usually present a more comple x problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cas es. It is a safe, cheap, reproducible, pain-free procedure, which eliminate s the possibility of anal incontinence and can be performed under local ane sthesia. Copyright (C) 2000 S. Karger AG, Basel.