DOI: http://dx.doi.org/10.18203/2349-2902.isj20200811

Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

Davinder Koli, Pravin Kumar, Viraj Panda, Manu Vats

Abstract


Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.

Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.

Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.

Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.


Keywords


Cyanoacrylate glue, Faecal incontinence, Fistula in ano

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References


Parks AG, Gordon PH, Hardcastle JD. A classification of fistula‐in‐ano. Bri J Surg. 1976;63(1):1-2.

Owen HA, Buchanan GN, Schizas A, Cohen R, Williams AB. Quality of life with anal fistula. Annal Royal Coll Surg Eng. 2016;98(5):334-8.

Ritchie R, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Color Dis. 2009;11(6):564-71.

Jordán J, Roig JV, García‐Armengol J, García‐Granero E, Solana A, Lledó S. Risk factors for recurrence and incontinence after anal fistula surgery. Color Dis. 2010;12(3):254-60.

Sentovich SM. Fibrin glue for anal fistulas. Dis Colon Rectum. 2003;46(4):498-502.

Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD. A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum. 2002;45(12):1608-15.

Dayyeh BK, Thosani N, Konda V, Wallace MB, Rex DK, Chauhan SS, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastroint Endo. 2015;81(3):502-e1.

Barillari P, Basso L, Larcinese A, Gozzo P, Indinnimeo M. Cyanoacrylate glue in the treatment of ano-rectal fistulas. Inter J Color Dis. 2006;21(8):791-4.

Shivashanka SC, Nayaka AN, Manangi M, Rao S, Masanashetty SN. Efficacy of cyanoacrylate glue in anal fistulas. Inter Surg J. 2019;6(4):1352-5.