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Gastroenterology (Expert Forum)
Anal Fistula
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Anal Fistula
by Bourre', Jun 17, 2002 12:00AM
I have recently been treated (had it drained) for an anal abcess and I am concerned about the possibility of this progressing to a fistula. My Dr. said that "the only" way to fix a fistula is surgery.
With some minimal time I have found where antibiotics have been used for treatment with some success, as well as the "glue" listed in the question from your archives in 1998(see below).
Here are my questions:
1. Should antibiotics or this glue be attempted prior to surgical intervention?
2. How long will an abcess normally drain before it heals or it becomes a fistula.
3. What will happen if I take the "wait and see" course with this abcess?
4. How will I know that a fistula has developed, and it is not just the abcess draining?
Thank You so much for your time!!!
Bourre'
Subject: Fibrin Glue for Anal Fistula
I have developed an anal fistula as a result of having an absess, which was surgically drained. My physician is recommending the use of fibrin glue rather than surgery. The glue would be prepared from blood donated by myself.
_Dear Jim,
Fibrin tissue glue is a biological product that can stimulate wound healing. I don’t believe that it is a standard agent used in the United States for the treatment of fistulae but that it is considered experimental. Nevertheless, I performed a literature search to see if fibrin glue has been described as a treatment to close fistulae. Fibrin glue has been used to close many different types of fistulae. I did find a small, randomized study from Taiwan published in the British Journal of Surgery in January 1996.
With some minimal time I have found where antibiotics have been used for treatment with some success, as well as the "glue" listed in the question from your archives in 1998(see below).
Here are my questions:
1. Should antibiotics or this glue be attempted prior to surgical intervention?
2. How long will an abcess normally drain before it heals or it becomes a fistula.
3. What will happen if I take the "wait and see" course with this abcess?
4. How will I know that a fistula has developed, and it is not just the abcess draining?
Thank You so much for your time!!!
Bourre'
Subject: Fibrin Glue for Anal Fistula
I have developed an anal fistula as a result of having an absess, which was surgically drained. My physician is recommending the use of fibrin glue rather than surgery. The glue would be prepared from blood donated by myself.
_Dear Jim,
Fibrin tissue glue is a biological product that can stimulate wound healing. I don’t believe that it is a standard agent used in the United States for the treatment of fistulae but that it is considered experimental. Nevertheless, I performed a literature search to see if fibrin glue has been described as a treatment to close fistulae. Fibrin glue has been used to close many different types of fistulae. I did find a small, randomized study from Taiwan published in the British Journal of Surgery in January 1996.
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I'll try to answer some of your questions. First, using a glue prepared from your blood is a new procedure for fistula repair and its results have not been all that promising. What usually happens is the glue holds for weeks or months and then fails and you are back to square one. Your MD was right--the best way to heal a fistula is with surgery where the fistula passageway is converted to a groove to promote healing from the inside out. That being said if you want to try the glue first there is nothing wrong with that--the surgery will still be available is you need it later. Personally, I would try anything first and leave surgery for a last solution.
<< 1. Should antibiotics or this glue be attempted prior to surgical intervention?>>---Like I said you can try these before surgery and leave surgery for a last option.
<<2.How long will an abcess normally drain before it heals or it becomes a fistula.>>---Every abscess doesn't progress to a fistula. The percentages are fairly high however, about 50% of abscesses progress to fistulas. The absces is difficult to heal if left alone because is has a poor blood supply and antibiotics do little because the abscess doesn;t have the blood supply needed to take the antibiotics to the infection.
<<3. What will happen if I take the "wait and see" course with this abcess?>>---Who knows. I guess it could heal itself but that is least likely of the other options. You have to remember that an abscess progresses to a fistula in 50% of the cases *even with* medical drainage.
<<4. How will I know that a fistula has developed, and it is not just the abcess draining?>>--Since a fistula is a passageway or tunnel yo may see some fecal material coming out of the fistula--and that would be proof that the passage goes from inside the intestine to the outside.
Francis