Value of MR imaging in diagnosis and follow-up of perianal fistula after fibrin sealant

Fibrin glue has recently been shown to be a successful modality for treatment of complex perianal fistulas and is associated with a higher degree of patient satisfaction. Fistula healing after fibrin glue application can only be determined by adequate follow-up, with consideration of underlying tract activity not just skin healing which can be achieved by MR imaging. This study was designed to evaluate the role of MR imaging in patient selection and prediction of outcome of fibrin sealant treatment in patients with complex perianal fistulas. Twenty-four patients underwent fibrin glue after fistula tract preparation and followed up for a median of
16 months. Clinical and MRI assessment were performed to patients who had early signs of skin healing. Based on their preoperative MRI appearances, 17 patients (70.8%) had transsphincteric fistula, 5 (20.8%) had suprasphincteric fistula and 2 (8.4%) had extrasphincteric fistula. Twenty cases (83.3%) showed skin healing at a median of six (range, 2-15) weeks, 14 cases out of them remained healed till the end of follow up period (range 9-26 months) while10 cases had relapses and fistula recurrence. The success rate was 58.3% while recurrence was reported in 41.7%. In conclusion, fibrin sealant injection is a safe and useful treatment in the management of complex perianal fistula and precludes the need for more extensive surgery. MR imaging can accurately predate the clinical assessment in prediction of the outcome at an earlier stage. More than one half of the patients can actually be cured with fibrin glue when considering combined clinical and radiological evidence