Improved Outcomes in Colon and Rectal Surgery part 21. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | IMPROVED OUTCOMES IN COLON AND RECTAL SURGERY more favorable outcomes Zmora et al. were able to achieve a 53 healing rate in a prospective study of 60 patients with complex cryptoglandular fistulas treated with fibrin glue with intraadhesive ceftazidime. 63 The wide variety of successful healing in studies looking at the use of fibrin glue in the treatment of fistula-in-ano is multifactorial. Differences in the trials include patient selection use of autologous versus commercially prepared fibrin adhesive etiology of the fistula cryptoglandular vs. Crohn s disease vs. other causes complexity of the fistula and length of follow-up. While the application of the tissue adhesive seems fairly straightforward there are also assuredly subtle differences in the application techniques of different surgeons. The heterogeneity of the published trials makes direct comparisons very difficult. While success rates vary over a wide range the advantages of attempting to treat high transsphincteric fistulas with fibrin glue in terms of simplicity of technique negligible complication rate and ease of reapplication for failed treatments make it an attractive option at least initially. Most surgeons seem willing to accept a higher than expected failure rate in exchange for a low complication rate understanding that treatment failures will need to be addressed in some other manner. Anal Fistula Plug The topic that has perhaps generated the most discussion in recent years is the use of the Surgisis Anal Fistula Plug AFP Cook Surgical Inc. Bloomington IN . The AFP is a cone shaped bio-prosthetic fashioned from Surgisis a bioabsorbable xenograft made of lyophilized porcine intestinal submucosal. Surgisis has been used extensively in abdominal and inguinal hernia repairs. 64-66 It is relatively resistant to infection produces no foreign body or giant cell reaction and becomes repopulated with host cell tissue within 3-6 months providing mechanical integrity while acting as a scaffold to .
