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Gastroenterology Research and Practice
Volume 2011, Article ID 186350, 7 pages
Clinical Study

Staged Mucosal Advancement Flap versus Staged Fibrin Sealant in the Treatment of Complex Perianal Fistulas

Department of Surgery, Academic Hospital of Maastricht, 6202-AZ Maastricht, The Netherlands

Received 16 January 2011; Revised 18 April 2011; Accepted 30 May 2011

Academic Editor: Bo Shen

Copyright © 2011 S. J. van der Hagen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. In this prospective randomised study, the staged mucosal advancement flap is compared with staged fibrin sealant application in the treatment of perianal fistulas. Methods. All patients with high complex cryptoglandular fistulas were randomised to closure of the internal opening by a mucosal advancement flap (MF) or injection with fibrin sealant (FS) after treatment with setons. Recurrence rate and incontinence disorders were explored. Results. The MF group (5 females and 10 males) with a median age of 51 years and a median followup of 52 months. The FS group (4 females and 11 males) with a median age of 45 years and a median followup of 49 months. Three (20%) patients of the MF group had a recurrent fistula compared to 9 (60%) of the FS group ( ). No new continence disorders developed. Conclusion. Staged FS injection has a much lower success rate compared to MF.