Fibrin tissue adhesive offers a unique mode of managing fistulas-in-ano, which is surgically less invasive, but recurrences up to one year later are being seen. Longer follow-up and further research is recommended for improvement.

These results confirm that preoperative evaluation by an enterostomal therapist, marking of the skin site, and providing patient education reduce adverse outcomes. All elective procedures that may result in stoma formation should, therefore, be assessed and marked preoperatively. Patients, likewise, should be informed and taught to care for their forthcoming stomas preoperatively and postoperatively.

Staged fistulotomy using a seton is a safe and effective method of treating high or complicated anorectal fistulas.

Parastomal hernia is a common complication of stoma formation, having an incidence of about 10%. As with many other ostomy-associated complications, most parastomal hernias are related to inadequate pre-operative planning or technical errors. Most of these hernias should be managed conservatively; only 10-20% of patients eventually require operative intervention. When an operation is indicated, relocating the stoma generally yields better long-term results than does an attempt at local repair of the hernia.

Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.

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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 the risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.

Treatment of fistula-in-ano with fibrin sealant with closure of the internal opening was somewhat more successful than sealant with cefoxitin or the combination, however this did not achieve statistical significance. None of the three modifications were more successful than historic controls at our institution treated with sealant alone. Therefore, the addition of intra-adhesive cefoxitin, closure of the internal opening, or both are not recommended modifications of the fibrin sealant procedure.