| Fibrin glue for the treatment of fistulae in ano--a method worth sticking to? | |
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MedLine Citation:
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PMID: 19220380 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The current evidence for fibrin glue as a treatment for anal fistulae is mixed. This study reviews the experience of fibrin glue as a treatment for anal fistulae in a single tertiary referral centre and attempts to identify factors related to failure of therapy and the length of follow-up required. METHOD: Patients with fistulae in ano that were treated with fibrin glue between February 2004 and August 2008 were analysed. All procedures were performed by two colorectal consultants based at the Queens Medical Centre, Nottingham. All patients were followed-up to assess the outcome of this treatment. RESULTS: Forty patients (21 male, 19 female) with a mean age of 46.5 years were studied. The mean duration of symptoms prior to presentation was 39 months (range 4-240 months). Presenting symptoms included perianal discharge (72.5%), perianal abscess (57.5%), pain (12.5%), PR bleeding (7.5%), itching (5%) and urgency (2.5%). Patients had a minimum of two follow-up appointments and the median follow-up period was 5.2 months (range 1-16 months). Following MRI and operative assessment, 28 (70%) of the 40 fistulae were considered complex (high trans-sphincteric, extra-sphincteric, pouch-vaginal). Patients who had inflammatory bowel disease were classified as simple tracts but all failed to heal (three patients). Twenty of the complex fistulae failed to heal. Three patients who had repeat application of glue for their complex fistulae failed to heal on follow-up. Of the remaining 12 patients who had simple fistulae in ano, five (41.7%) healed completely. There were no complications such as abscess, related to treatment. All patients who were asymptomatic at 3 months did not develop any further recurrence. CONCLUSION: Fibrin glue is a simple treatment strategy, preserves sphincter function with minimal adverse side effects. It should therefore be considered as possible first line treatment in simple fistulae but it is less likely to be successful in complex or those fistulae associated with inflammatory bowel disease. Repeat gluing is unlikely to be successful. Fistulae that have failed to heal by 3 months will need further treatment. |
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Authors:
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J M C Yeung; J A D Simpson; S-W Tang; N C Armitage; C Maxwell-Armstrong |
Publication Detail:
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Type: Journal Article Date: 2009-02-07 |
Journal Detail:
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Title: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Volume: 12 ISSN: 1463-1318 ISO Abbreviation: Colorectal Dis Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-05-07 Completed Date: 2010-08-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883611 Medline TA: Colorectal Dis Country: England |
Other Details:
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Languages: eng Pagination: 363-6 Citation Subset: IM |
Affiliation:
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Department of Colorectal Surgery, Peter MacCallum Cancer Unit, Melbourne, Australia. justinyeung@doctors.org.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Curettage Female Fibrin Tissue Adhesive / therapeutic use* Follow-Up Studies Humans Male Middle Aged Rectal Fistula / surgery, therapy* Tissue Adhesives / therapeutic use* Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Tissue Adhesive; 0/Tissue Adhesives |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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