Fibrin Glue

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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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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