[Long-term follow-up of the treatment of high anal fistulas using fibrin glue]. / Fistules anales trans-sphinctériennes hautes traitées par colle biologique : suivi à long terme.

AIM OF THE STUDY: Many of the treatments proposed for trans-sphincteric and suprasphincteric anal fistulas are complex and often associated with permanent damage to the sphincter mechanism. In this study, we evaluate the long-term stability of fistula closure using fibrin glue. MATERIALS AND METHODS: Forty-five consecutive patients (mean age 41.5) underwent this procedure. Follow-up was obtained from all patients and their primary care physicians by January 1, 2008. RESULTS: Mean follow-up was 67 months. All recurrences occurred in the first six months after the initial fibrin glue injection procedure; there were no late recurrences. CONCLUSION: Long-term follow-up confirmed the safety, efficacy and durability of fibrin glue fistula closure.

[Biological fibrin used in anal fistulas: 31 patients]. / Colle biologique dans les fistules anales: à propos de 31 patients.

AIM OF THE STUDY: The different treatments proposed for transsphincteric and suprasphincteric cryptoglandular anal fistulas are often complex and often associated with complications. After one or two stage anal fistulotomy, the risk of change in fecal continence ranks from 30% to 40%. This rate is lower (10%) with transanal advancement flap repair technique. A new therapeutic approach (fistula track closure by means of a fibrin sealant) that we have developed in our study allows to avoid classical sphincter dissection or section which could jeopardize normal sphincter function. PATIENTS AND METHODS: Over a 20 month period, 31 consecutive patients (mean age: 42; 24 males and seven females) with transsphincteric (n = 28) or suprasphincteric (n = 3) anal fistula have been included in this study and treated with injection of a fibrin sealant into fistula track. Patients were controlled during a mean follow-up of 9 month. RESULTS: Fistula cure was obtained in 83.9% cases (75% after single fibrin sealant application). Success was achieved after a second application in two patients. Neither change in fecal continence nor other complication was observed during application and during follow-up period. CONCLUSION: This technique is simple (100% feasibility) and is reproductible. Results are comparable with "classical" techniques. However, despite this surgical procedure which could be seen as simple, it requires a throrough methodology.