A COMPARATIVE STUDY OF FISTULOTOMY AND FISTULECTOMY IN MANAGEMENT OF SIMPLE FISTULA IN ANO : STUDY OF 50 CASES

Dr Ameet Bhasme, Dr Yogendra P Chidrawar

Abstract


Background :  A fistula in ano is a pathway, lined by granulation tissue that joins deeply in the anal canal or rectum and superficially on the skin around the anus. A fistulectomy involves complete excision of the fistulous tract. Low anal fistulae have been mainly treated by fistulotomy with good results. However, Marsupialization of the fistulotomy wounds can reduce the healing time further. The purpose of this study was a randomized controlled trial that aimed to compare the fistulectomy to the fistulotomy with marsupialization in the management of simple anal fistula.

 Methods: Total 50 patients suffering from simple fistula in ano, admitted at tertiary care government hospital from January 2018 to December 2018 were divided into two groups. The simple fistula is defined as the fistula with one external and one internal opening alongwith a palpable tract. The 25 patients from group A had undergone fistulotomy with marsupialisation and 25 patients from group B had undergone fistulectomy procedure as a treatment modality for their low-lying anal fistula.

Results:   The mean duration of surgery in fistulotomy group was 25.2min and that of fistulectomy group was 32.8 min. The median duration of wound healing was shorter in the fistulotomy group (14 days) compared to the fistulectomy group (22 days) and the difference is statistically highly significant. The incidence of incontinence in fistulotomy group observed in 1 case compared to 2 cases in fistulectomy group. Recurrence observed in one case from both the groups each within 6 months post-op period.

Conclusions: According to the present study the results of fistulotomy and fistulectomy are comparable with respect to duration of surgery, postoperative pain and recurrence rate. The postoperative wound healing is faster in fistulotomy; incidence of anal incontinence is higher in fistulectomy group compared to fistulotomy. A large size study is required to establish the standard line of treatment for fistula in ano.


Keywords


Fistula in ano, Fistulectomy, Fistulotomy

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