C L I N I C A L E X P E R I E N C E & T E C H N I C A L I N F O R M A T I O N
EFFICACY OF
BIODEGRADABLE
PLUG
VERSUS
FIBRIN
GLUE IN
CLOSURE OF
ANORECTAL
FISTULAS
Eric K Johnson, MD; Janette U. Gaw, MD;
David Armstrong, MD, FRCS
Georgia Colon & Rectal Surgical Clinic;
Atlanta, Georgia
Purpose
Long-term closure rates of
anorectal fi stulas using Fibrin
glue have been disappointing,
possibly due to the liquid con-
sistency of the glue. A suturable
biodegradable plug (Surgisis,
Cook Surgical) was developed
to close the primary opening
of fi stula tracts. A prospective
study was performed to com-
pare Fibrin glue versus fi stula
plug.
Methods
Patients with anorectal fi stulas
were prospectively enrolled.
Patients with Crohn’s disease
were excluded. Age, gender,
number of fi stula tracts and
number of prior fi stula surger-
ies were compared between
groups. Patients underwent
thorough debridement and irri-
gation of the fi stula tract under
general anesthesia in a prone
jack knife position. The fi stula
tracts were occluded either
by Fibrin glue or by closure
of the primary opening using
a biodegradable fi stula plug.
Median follow up was three (3)
months in both groups.
TECHNICAL INFORMATION BULLETIN
Results
25 patients were prospectively
enrolled. 10 patients under-
went Fibrin glue closure, and
15 using a biodegradable plug.
Patients’ age, gender, number
of fi stula tracts and number of
prior closure attempts were
similar in both groups. In the
Fibrin glue group, 6 patients
(60%) had persistence of
one or more fi stulas at three
months follow up compared
with 2 patients (13%) in the
biodegradable plug group.
(P<0.05 Fisher’s exact test).
Conclusions
Closure of the primary
opening of a fi stula tract
using a suturable biodegradable
plug is an effective method of
treating anorectal fi stulas. The
method appears to be more
reliable than Fibrin glue closure.
The greater effi cacy of the
biodegradable plug may be due
to the ability to suture the plug
in the primary openi