Introduction 1 2 3 4 5 6 7 8 10 11 15 16 20 21 The aim of this study was to assess the additional value of fibrin glue to the transanal rectal advancement flap in a well-defined group of patients with high transsphincteric fistulas of cryptoglandular origin. Patients with previous fistula surgery are a surgically more challenging group as the result of scar tissue and sometimes anal stenosis. Therefore, patients were matched for the presence of a history of fistula surgery. Materials and methods Patient characteristics 22 Surgical technique Data collection Statistical analysis U p p Results n n n 1 2 Table 1 Characteristics of patients with high anorectal fistula without previous fistula surgery Variable n a n b p n 18:14 6:3 0.711 Age (median, in years) 42 (21–67) 41 (29–55) 0.653 Tertiary referral 26 (81%) 7 (78%) 1.000 Smoking 43% 71% 0.232 Seton drainage 18 (56%) 6 (67%) 0.711 a b Table 2 Characteristics of patients with high anorectal fistulas with previous fistula surgery Variable n a n b p n 18:4 11:6 0.282 Age (median, in years) 43 (22–62) 47 (35–72) 0.136 Tertiary referral 15 (68%) 8 (47%) 0.209 Smoking 53% 50% 1.000 Seton drainage 10 (46%) 12 (71%) 0.193 a b Clinical outcome n n n 3 p p n n n n p Table 3 Recurrence rates for the matched group analysis Group a b p n 9/54 (17%) 12/26 (46%) 0.050 n 4/32 (13%) 5/9 (56%) 0.014 n 5/22 (23%) 7/17 (41%) 0.216 a b Discussion 3 11 14 19 20 21 14 23 24 25 20 26 21 23