Treatment of Fistulas-in-Ano With Fibrin Sealant in Combination With Intra-adhesive Antibiotics and/or Surgical Closure of the Internal Fistula Opening

摘要: The treatment of fistulas-in-ano with fibrin sealant injection has been moderately successful. Failures can be caused by persistent infection within the tract or early expulsion clot. In an attempt to improve success rate, we examined three modifications procedure: addition cefoxitin sealant, surgical closure primary opening, both. A prospective, randomized, clinical trial was performed in which patients were treated Tisseel-VH ® according previously published procedures. addition, randomized receive intra-adhesive cefoxitin, both modifications. Cefoxitin, 100 mg, added for antibiotics. For appropriate patients, fistula opening closed a 3-0 absorbable suture. If fistulas failed heal, offered single retreatment sealant. Twenty-four arm, 25 and 26 combined arm. Median duration 12 months. Patients followed mean 27 months postoperatively. There no postoperative incontinence complications related itself. Initial healing rates 21 percent 40 31 arm (P = 0.35). One five one seven six successfully retreated; final 25, 44, 35 respectively 0.38). Treatment fistula-in-ano internal somewhat more successful than combination, however this did not achieve statistical significance. None historic controls at our institution alone. Therefore, are recommended procedure.