Bioglue for the Treatment of Anal Fistula is Associated with Acute Anal Sepsis

Excerpt

To the Editor—We read with great interest the work of de la Portilla and colleagues published in the February issue of Diseases of Colon and Rectum.1 In their article the authors reported the results of their preliminary experience with BioGlue® in the treatment of high anal fistulas. BioGlue® Surgical adhesive (Cryolife®, Inc., Kennesaw, GA) has been previously used as surgical sealant in cardiopulmonary and neurosurgical operations.2‐4 However, its use in gastrointestinal operations has not yet been established. The concept of fistula obliteration with an injectable substance is an attractive idea because of the minimal tissue trauma and risk associated with such a procedure. In the past fibrin glue was widely investigated as biologic glue and although early series reported an encouraging high success rate, larger studies with long-term follow-up have shown a low closure rate.5,6 BioGlue® [purified bovine serum albumin and glutaraldehyde] has emerged as a potential alternative. In their described series from Spain the authors reported 14 patients treated on an outpatient basis. All patients received one week of postoperative antibiotics and avoided sitting for long periods. In some patients the internal opening was closed and in others it was left open. A 50 percent success rate was observed in their cohort. In 43 percent of patients the plug of BioGlue® was expelled from the tract accompanied by purulent drainage. No patient required emergent reoperation for acute postoperative sepsis. …