A recent addition to our armamentaria is fibrin glue. Our technique is to place a noncutting Seton into the tract leaving it in place for 6 to 8 weeks. The Setons are removed and fibrin glue injected into the fistula tract. The internal opening is suture closed whereas the cutaneous one is left open.
Lindsey and colleagues (2002) performed a randomized trial of fibrin glue versus conventional fistula treatment in patients with and without CD. One hundred percent of simple fistulas healed with standard treatment and only 33% healed with fibrin glue injection. Of the complex fistulas, the cumulative healing rate after 1 to 2 treatments with fibrin glue was 69%. Sentovich (2003) reported on 48 patients with fistulas, among whom 10% were CD patients. The closure rate was 85%. Interestingly, the failure rate in their CD patients was only 20%. Over all, the healing rates of fistulas vary between 40% for CD patients and 80% for crypto glandular fistulas. Fibrin glue along with Seton placement may have a role to play in the treatment of complex perianal fistula with long tracts in patients with CD.
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