Role of Fibrin Glue versus Fistulotomy in Treatment of High Fistula-In-Ano

Background: Perianal fistula is a frequent surgical condition that affect patient’s daily activity, causing chronic pain and discomfort. High-type fistula-in-ano is especially hard to manage due to its position. Standard surgical methods are associated with many adverse events such as incontinence and repeated infections. Fibrin glue is a kind of biological glue which facilitates tract obliteration, with preservation of anal sphincter.Aim of the work: This study aims at comparing the efficacy of fibrin glue versus fistulotomy in the treatment of high perianal fistulas.Patients and Methods: In the present study, 30 patients diagnosed with a high-type perianal fistula were divided into two groups; group [1] undergone standard fistulotomy, and group [2] undergone fibrin glue. Operative outcomes, post-operative improvements and complications were compared.Results: Patients in group [2] had significant short operative time [31.1 ± 12.5 min. in group 1 vs. 19.7 ± 1.62 min. in group 2; P, 0.004]. Group 2 had a significantly shorter hospital stay length than group 1 [1.93 ± 0.79 days for group 1 and 1.31 ± 0.35 days for group 2; P, < 0.001]. No significant difference was shown between studied groups regarding pain improvement, wound infection, wound discharge and incontinence at one week following surgery. However, group 1 patients had a significant [P, <0.001] less healing time than group 2. At six months following surgery, patients in group 1 reported higher rate of infection [four patients vs. none in group 2; P, 0.03] and higher recurrence rate [six in group 1 vs. one patient in group 2; P, 0.03].Conclusion: The use of fibrin glue injection is a viable, valuable, and effective alternative for treating fistula-in-ano. It is associated with lower complications and less recurrence, although it had longer time for complete healing.