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Fibrin glue in the management of anal fistulae
Author(s) -
Hammond T. M.,
Grahn M. F.,
Lunniss P. J.
Publication year - 2004
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2004.00676.x
Subject(s) - medicine , anal fistula , fibrin glue , surgery , fistula , medline , adverse effect , meta analysis , randomized controlled trial , systematic review , clinical trial , intensive care medicine , political science , law
Objective Fibrin glue has been used as a sphincter sparing approach for the treatment of anal fistulae for two decades. However, there is uncertainty about its short and long‐term efficacy. The objective of this review was to ascertain the role of fibrin glue in the management of anal fistulae, including assessment of recurrence rates, continence disturbance and other complications. Methods We searched Medline (January 1966 to February 2004), the Cochrane database, and EMBASE using the terms anal fistulae, fistula‐in‐ano, and fibrin glue. Relevant papers from the reference lists of these articles and from the authors' personal collections were also reviewed. A systematic review of all articles relating to the use of fibrin glue in the treatment of anal fistulae was performed. This included 19 studies. Reviewers performed data extraction independently. Outcomes evaluated included recurrence rates, continence disturbance, septic complications, adverse drug reactions, and duration of follow‐up. Heterogeneity of the clinical trials made direct comparisons difficult and meta‐analysis impossible. Results The success rates reported in published studies range from 0% to 100%. Differences in patient selection (including fistula aetiology and type), treatment protocols, and follow‐up duration may contribute to such diverse results. Conclusions Fibrin glue is simple to use, has a minimal morbidity and should not affect later treatment options in the event of its failure. It is therefore theoretically attractive as a first line treatment in the management of those types of anal fistula in which it has been shown to work. However, further research into ‘biological’ glues is merited and these subject to randomised controlled study.