Reducing the rate of fistula: does a fibrin sealant act as an adjunct in pharyngeal closure? A two-centre experience

Abstract

Background Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula. Method A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases. Results In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula. Conclusion The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.

Loose combined cutting seton for patients with suprasphincteric anal fistula: a randomized clinical trial protocol

“…FGS is a treatment method in which fibrin glue is injected into the fistula after the internal opening and the fistula are scraped, and a clot is formed in contact with the wound surface, thereby filling the fistula. However, studies have shown that the cure rate of fibrin glue occlusion fluctuates greatly, ranging from 14% to 90% (17). Therefore, achieving high cure rates while protecting anal function remains a significant challenge.…”