الفهرس 
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AnatomyOnly 14 pages are availabe for public view
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Abstract
A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening .
Most fistulas are thought to arise as a result of cryptoglandular infection with resultant perirectal abscess The abscess represents the acute inflammatory event, whereas the fistula is representative of the chronic process. Symptoms generally affect quality of life significantly, and they range from minor discomfort and drainage with resultant hygienic problems to sepsis.
The true prevalence of fistula-in-ano is unknown. The incidence of a fistula-in-ano developing from an anal abscess ranges from 26% to 38%. One study showed that the prevalence of fistula-in-ano is 8.6 cases per 100,000 population. In men, the prevalence is 12.3 cases per 100,000 population, and in women, it is 5.6 cases per 100,000 population. The male-to-female ratio is 1.8:1. The mean patient age is 38.3 years.
The most common investigation methods used in diagnosis of perianal fistula are fisulogram but it has some fales results and MRI but it expensive method not all patients can do it.
Other un common methods computed tomography and endorectal ultrasound .
Treatment of peri anal fistula mainly by surgery and many surgical techniques are used but with higher rates of complications as disturbed sphincteric function leading to loss of control of flatus and stool-seve post operative pain and discomfort –intra operative bleeding and infection of post operative wound produced by surgery.
These methods are fistulotomy –fistulectomy –seton placement-endorectal advancement flap-and ligation of inter sphincteric fistula tract.
Fibrin gue:
Fibrin glue is a tissue adhesive that simulates the terminalsteps of the natural clotting cascade. The sealant degrades as the fibrotic reaction progresses, ultimately getting fully replaced by the natural tissue.
Therefore, no foreign body persists and the tract scars simply closed.
Fibrin gluing of anal fistulas is simple and repeatable
The mentioned factors make this technique a highly desirable treatment option.
Fibrin tissue adhesive was first successfully used as a hemostatic agent in the early1900.
Although prior to 1998, the operative procedure for fibrin glue injection of anal fistula treatment in th United States was performed using autologous fibrin sealant, currently most surgeons utilize commercially prepared fibrin sealant when gluing anorectal fistulas.
These operative procedures are typically performed in outpatient settings. Oral and/or intravenous antibiotics are not necessary. Determination of the fistula primary or internal opening location is essential in order to improve the success rate of the procedure.
The tract should then be gently debrided without undue dilatation. After debridement, the tract should be irrigated with saline or hydrogen peroxide for cleansing it.
The sealant is slowly injected at the internal opening and allowed to set. The clot is allowed to solidify for 5-10 minutes. dressing.
Then The patients is followed up in the post operative period at the first week , at the first month ,at three months and at six moths like in the out patient clinic.
Conclusion
Injection of fibrin glue in perianal fistula is simple- easy-safe technique with lower rate of complication as loss of sphincteric function –post operative pain – intra operative bleeding and post operative wound infection and this technique can be repeated even at the out patient cl.