The Role of Fibrin Glue in the Treatment of High and Low Fistulas in Ano

Mishra, Atul

doi:10.7860/jcdr/2013/5387.2964

Cited by 17 publications

(18 citation statements)

References 11 publications

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“…Sixtythree percent of failure was noted in recurrent, surgically treated AF, even more likely among the high transsphincteric AFs (p < 0.05). 53 Similar results with recurrent AFs were reported by Loungnarath et al 54 (62%) and by Park et al 41 (50%) in their trials. Several explanations have been proposed including the difficulty in finding the original tract, the presence of side branches, dense fibrosis, and adhesions that may prevent healing and facilitate dislodgment of the clot.…”

Section: Fibrin Gluesupporting

confidence: 83%

Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

Scoglio

Walker

Fichera

2014

Clinics in Colon and Rectal Surgery

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). CME Objectives: After reading this article, the reader should be able to understand the role of biologic and synthetic materials for treatment of anal fistula.An anal fistula (AF) is an abnormal communication between the anal glands and the perianal skin. Reliable data on incidence of AF in the general population are not available, but in an epidemiologic study performed in four European countries (England, Germany, Italy, and Spain), the incidence reported was between 12 and 28 per 100,000. 1 The disease presents predominantly in the third and fourth decades of life 2 and it is more common in men than in women (12.3 vs. 5.6 per 100,000 cases). 1 According to the cryptoglandular hypothesis, intersphincteric gland infection is the initiating event in the formation of AF 3 and it usually develops in approximately one-third of patients who presents with a perirectal abscess. In a series 4 of 170 patients with no history of previous AF followed for an average of 99 months after abscess drainage, a fistula occurred in 37% and recurrent abscess was reported in an additional 10%. A retrospective cohort study 5 of 148 patients with anorectal abscesses showed again a 37% rate of fistula formation. Patients younger than 40 years had a higher likelihood of developing an AF during a mean follow-up of 38 months. Any recurrent abscess presenting at the same site should raise the suspicion of a fistula and be treated as such. There are several other causes of atypical/complicated abscess and fistula such as inflammatory bowel disease, fungal infection, mycobacterial infection, neoplasm, and trauma. Fistulas that are secondary to these processes are classified as complex and require the use of nonstandard methods of management.In 1976, Parks et al 6 classified AF in four different types according to their passage through the sphincteric planes: intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric (►Table 1). The most common presentation is intersphincteric, followed by transsphincteric. The remaining types are relatively uncommon. This is the most widely used classification. 7 However, a more practical approach is based on whether the internal opening is high or low within the anal canal. Low transsphincteric fistulas involve the lower third of the external anal sphincter mechanism and are generally treated by fistulotomy with a high success rate for cure. High transsphincteric fistulas involving the upper two-thirds of the external sphincter remain a surgical challenge because incontinence may result from the division of muscle involving more than one-third of the sphincter. The basic principles in the treatment of anorectal abscess and AF include eradication of perineal sepsis, complete AbstractAnal fistula (AF) presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates...

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Section: Fibrin Gluesupporting

confidence: 83%

Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

Scoglio

Walker

Fichera

2014

Clinics in Colon and Rectal Surgery

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“…Although we treated cases classified as "complex fistula," more than 60% of the patients who received two doses of fibrin glue under our minimally invasive surgical protocol had complete resolution of the fistula 1 year later, and these results were better than those associated with a more aggressive surgical protocol. 20 We consider that the new surgical protocol based on a "cleaning surgery" (deep curettage) played a major role in the high number of fistula closures observed in both groups, particularly when considering that all patients had undergone more than two failed surgeries before being included in this trial.…”

Section: Discussionmentioning

confidence: 99%

Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: A randomized clinical trial with long-term follow-up

García‐Arranz

García-Olmo

Herreros

et al. 2019

Stem Cells Translational Medicine

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The aim of this clinical trial (ID Number NCT01803347) was to determine the safety and efficacy of autologous adipose‐derived stem cells (ASCs) for treatment of cryptoglandular fistula. This research was conducted following an analysis of the mistakes of a same previous phase III clinical trial. We designed a multicenter, randomized, single‐blind clinical trial, recruiting 57 patients. Forty‐four patients were categorized as belonging to the intent‐to‐treat group. Of these, 23 patients received 100 million ASCs plus intralesional fibrin glue (group A) and 21 received intralesional fibrin glue (group B), both after a deeper curettage of tracks and closure of internal openings. Fistula healing was defined as complete re‐epithelialization of external openings. Those patients in whom the fistula had not healed after 16 weeks were eligible for retreatment. Patients were evaluated at 1, 4, 16, 36, and 52 weeks and 2 years after treatment. Results were assessed by an evaluator blinded to the type of treatment. After 16 weeks, the healing rate was 30.4% in group A and 42.8% in group B, rising to 55.0% and 63.1%, respectively, at 52 weeks. At the end of the study (2 years after treatment), the healing rate remained at 50.0% in group A and had reduced to 26.3% in group B. The safety of the cellular treatment was confirmed and no impact on fecal continence was detected. The main conclusion was that autologous ASCs for the treatment of cryptoglandular perianal fistula is safe and can favor long‐term and sustained fistula healing.

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“…Treatment options for repair and eradication of anal fistula bear the risk of postoperative faecal incontinence. Minimally invasive, sphincter‐preserving treatments minimize risk of postoperative faecal incontinence, but success rates have been low . Biological infill materials used to fill and close the fistula tract can support and promote tissue healing without damage to the sphincter muscle or surrounding tissue.…”

Section: Introductionmentioning

confidence: 99%