Seton or Glue for Trans-sphincteric Anal Fistulas

NCT ID: NCT00929630

Last Updated: 2009-09-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

65 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-01-31

Study Completion Date

2007-06-30

Brief Summary

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Surgical treatment of perianal fistulas frequently affects fecal continence. Sphincter saving techniques like loose or cutting seton and fistulectomy with advancement of an endorectal flap have been advocated to minimize the risk of sphincter injury, but patients often complain of a prolonged healing period and major discomfort. Furthermore, the healing rate varies widely according to the type of fistula and the surgeon's experience.In the early '90s the treatment of perianal fistulas by autologous or commercial fibrin glue was suggested and the American FDA approved the use and marketing of a human fibrin glue in 1998.

Since then, several studies have evaluated the effectiveness of human fibrin glue in the treatment of different types of perianal fistulas, reporting a wide range of success rates ranging from 31 to 85%.

Primary aim of this study is to conduct a prospective randomized trial evaluating the effectiveness of glue treatment of perianal fistulas as compared with the classical seton treatment. Secondary aims are to compare postoperative faecal incontinence, postoperative anal pain, healing time and length of hospitalization.

Detailed Description

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Background: Fibrin glue treatment of anal fistulas has been proposed to minimize the risk of faecal incontinence but its acceptance by coloproctologists is still poor because clear data in literature are lacking. We will run a prospective randomised trial comparing commercial fibrin glue treatment with classical seton treatment, taking into account the healing rate, hospital stay, healing time, faecal incontinence and postoperative pain.

Patients and Methods: 130 homogeneous patients with trans-sphincteric anal fistulas referred to 7 Colorectal Units will be randomised to undergo fibrin glue or seton treatment. permanent healing of the fistula will be defined as absence on any discharge from the fistula and healing of the secondary fistula orifice after at least 1 year of follow up.

Post operative pain (on a VAS scale) and hospital stay will be recorded and compared in the two groups

Conditions

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Anal Fistulas

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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glue (Tissucol ) treatment

patients with transsphincteric anal fistulas of cryptoglandular origin never operated on before

Group Type EXPERIMENTAL

glue (Tissucol) treatment

Intervention Type PROCEDURE

After preparation of the fistula, a quantity of biological glue (Tissucol) is injected into the fistula tract

Fistula closing with biological glue

Intervention Type PROCEDURE

After cleaning and disinfection of the fistula tract, abot 1-2 ml of Tissucol (biological Glue) is inserted into the fistula tract to close it

Seton treatment

patients with transsphincteric anal fistulas of cryptoglandular origin never operated on before

Group Type ACTIVE_COMPARATOR

transsphincteric Seton positioning

Intervention Type PROCEDURE

A cutting seton is applied into the fistula tract

Seton positioning into the fistula tract

Intervention Type PROCEDURE

Under spinal anesthesia a Seton is positioned into the fistula tract.

Interventions

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transsphincteric Seton positioning

A cutting seton is applied into the fistula tract

Intervention Type PROCEDURE

glue (Tissucol) treatment

After preparation of the fistula, a quantity of biological glue (Tissucol) is injected into the fistula tract

Intervention Type PROCEDURE

Fistula closing with biological glue

After cleaning and disinfection of the fistula tract, abot 1-2 ml of Tissucol (biological Glue) is inserted into the fistula tract to close it

Intervention Type PROCEDURE

Seton positioning into the fistula tract

Under spinal anesthesia a Seton is positioned into the fistula tract.

Intervention Type PROCEDURE

Other Intervention Names

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seton treatment of the fistula fibrin glue treatment of perianal fistulas fibrin glue treatment of perianal fistulas loose seton, cutting seton for anal fistulas

Eligibility Criteria

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Inclusion Criteria

* medium or high trans-sphincteric fistulas of cryptoglandular origin, no previous treatments

Exclusion Criteria

* Crohn's disease
* anal abscesses
* complex fistulas (horse-shoe type or multiple secondary tracts)
* immunosuppression
* diabetes,
* anal fissures
* pregnancy
* anti-coagulant treatments,
* any allergic reaction to the bioglue components.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Societa Italiana di Chirurgia ColoRettale

NETWORK

Sponsor Role lead

Responsible Party

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Italian Society of Colorectal surgery

Principal Investigators

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Donato F Altomare, MD

Role: PRINCIPAL_INVESTIGATOR

University of Bari

Locations

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Dept of Emergency and Organ transplantation - University of Bari

Bari, , Italy

Site Status

Countries

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Italy

Other Identifiers

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SICCR 10/2006

Identifier Type: -

Identifier Source: org_study_id

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