Fistulotomy versus fistulectomy for treatment of fistula-in-ano

• Published in: Journal of evolution of medical and dental sciences p. 3217
• Main Authors: Ravi, Kumar H, Sunil, Kumar S.R, Gosavi, Siddharth
• Format: Journal Article
• Language: English
• Published: Akshantala Enterprises Private Limited 23.06.2016
• Subjects: Analysis; Care and treatment; Fistula; Health aspects; Infection; Inflammation
• ISSN: 2278-4748; 2278-4802
• DOI: 10.14260/jemds/2016/746

Fistula-in-ano is notorious for its frequent exacerbations, recurrences and its chronic condition. The anorectal abscess is an acute inflammatory process that often is the initial manifestation of the underlying anal fistula and is the chronic condition following inadequate drainage of the abscess. Around 90% of the cases occur due to infected anal glands. Incision and drainage of the abscess cavity will result in complete resolution of the infection in 50% of the patients, whereas in the rest an anal fistula will develop. Most patients with an overt fistula have an antecedent history of abscess that drained spontaneously or for which surgical drainage had been performed. There are different surgeries mentioned in literature. The ultimate goal of fistula surgery is to eradicate it without disturbing or minimally disturbing the anal sphincter mechanism. MATERIALS AND METHODS A total number of 300 patients diagnosed with low fistula-in-ano were included in this clinical study. These 300 patients presented to the general surgery OPD and were admitted under the Department of General Surgery in Vydehi Institute of Medical Sciences and Research Centre during the period of April 2012 to Jan 2016. The patients were not randomized for any imaging modality or surgical procedures. Detailed history including the past history of anorectal abscess and of previous fistula surgery was taken. The mode of presentation, other comorbid conditions like diabetes, the findings on clinical examination (Digital examination and proctoscopy) were recorded in the case sheet for individual patients. Complete blood count, random blood sugar, HIV, HBsAg, sono-fistulogram were done. The discharge from the external opening was sent for culture and sensitivity studies. High anal fistulas and tuberculous fistulas were excluded from the study. RESULTS 150 patients were treated with fistulotomy and 150 patients were treated with fistulectomy. More number of males had fistula compared to women; 15 out of 150 patients who underwent fistulectomy had recurrence. However, none of the patients who underwent fistulotomy had any recurrence. Average duration of the patient in the hospital following surgery was 4 days. None of the patients had any anal incontinence. Histopathology report following findings of patients who underwent fistulectomy showed nonspecific inflammation. CONCLUSION According to our clinical study fistulectomy for fistula-in-ano has higher chance of recurrence. Both the surgical procedures had no anal incontinence. Hence, for an uncomplicated low fistula-in-ano fistulotomy is a better surgical procedure. KEYWORDS Fistulotomy, Fistulectomy.