Study on Comparative Analysis on Fistulotomy and Fistulectomy in the Management of Low Anal Fistula

Document Type : Research/Original Article

Authors

Department Of Surgery Era's Lucknow Medical College & Hospital, Lucknow, Uttar Pradesh,India.

10.30476/acrr.2023.96873.1156

Abstract

Introduction- Infected anal crypts are the most prevalent cause of an anal fistula, a pathological relationship that exists between the anal canal and perianal skin. The present study aimed to compare fistulotomy and fistulectomy in the management of low anal fistula.
Method- In this prospective comparative study, a total of 90 patients of age >18 years with patients with low-lying anal fistula were included. Out of 90 patients, 45 patients underwent fistulectomy and 45 patients underwent fistulotomy as the treatment for low anal fistula and were follow-up for 3 months. Routine blood investigations like haemoglobin and complete blood count were carried out. Mean operative time, healing time, flatus incontinence, and pain was compared.

Results- The mean age of the patients were 39.66±10.80 yrs with male dominancy (86.7%) in both groups. Mean Operative time of patients of Fistulectomy Group (35.31±7.48 min) was significantly higher (p=0.005) than that of Fistulotomy Group (31.33±5.39 min). In Fistulectomy Group, the mean healing time was significantly higher (28.69±4.56 days) as compared to Fistulotomy Group (24.87±4.79 days) (p<0.001). The VAS score was significantly higher in Fistulectomy Group as compared to Fistulotomy Group (p<0.001). However, differences in complaints of Flatus incontinence among patients of the above two groups were not found to be significant at any of the follow up (p>0.05). There was no case of recurrence in either of the two groups.

Conclusion- Fistulotomy was found to be a better option for the management of low anal fistula patients having benefits of lower surgical duration, early healing, and lower complications.

Keywords


1. Gosselink MP, van Onkelen RS,
Schouten WR. The cryptoglandular
theory revisited. Colorectal disease :
the official journal of the Association
of Coloproctology of Great Britain
and Ireland. 2015;17(12):1041-3.
2. Shindhe PS. Management of
rare, low anal anterior fistula
exception to Goodsall’s rule with
Kṣārasūtra. Ancient science of life.
2014;33(3):182-5.
3. Adams D, Kovalcik PJ. Fistula in ano.
Surgery, gynecology & obstetrics.
1981;153(5):731-2.
4. Nelson RL, Abcarian H. Epidemiology,
Incidence and Prevalence of Fistula
in Ano. In: Abcarian H, editor. Anal
Fistula: Principles and Management.
New York, NY: Springer New York;
2014. p. 1-3.
5. Bubbers EJ, Cologne KG.
Management of Complex Anal
Fistulas. Clinics in colon and rectal
surgery. 2016;29(1):43-9.
6. Ganesan R KK, Heber Anandan.
A comparative study between
fistulotomy and fistulectomy in
management of low anal fistulae.
International Surgery Journal. 2017
4(11):3665-9.
7. Xu Y, Liang S, Tang W. Meta-analysis
of randomized clinical trials
comparing fistulectomy versus
fistulotomy for low anal fistula.
SpringerPlus. 2016;5(1):1722.
8. Ratto C, Litta F, Donisi L, Parello
A. Fistulotomy or fistulectomy and
primary sphincteroplasty for anal
fistula (FIPS): a systematic review.
Techniques in coloproctology.
2015;19(7):391-400.
9. Gafar A. Fistulotomy versus
fistulectomy as a t reatment for low
anal fistula in infants: A comparative
study. Annals of Pediatric Surgery.
2013;9:103-7.
10. Saber A. Patients Satisfaction and
Outcome of Fistulotomy versus
Fistulectomy for Low Anal Fistula.
Journal of Surgery. 2016;4(2-1):15-9
11. Barase A, Shinde A. A comparative
study of fistulotomy and fistulectomy
in management of simple fistula in
ano. International Surgery Journal.
2018;5:3704.
12. Atul Kumar Vyas AK, Abhinav Rathi,
Prateek Porwal, Rahul Jain, Praneeth
Etta. Comparison and Evaluation
of the Outcome of Fistulotomy Vs
Fistulectomy Technique in Treatment
of Low Fistula in Ano. Journal
of Medical Science And clinical
Research. 2016;4(12).
13. Vikash Katiyar1 AG, Vivek Singh.
Low lying fistula-in-ano -fistulotomy
or fistulectomy. Asian Pac J Health
Sci. 2020;7(1):53-6.
14. Sheikh IA SI, Hanif MS, Rashid
MM, Karim M, Ateeq S. Fistulotomy
vs fistulectomy in the treatment of
simple low anal fistula of male
patients. . Pak Armed Forces Med J
2015;65(6):798-802.
15. Filingeri V, Gravante G, Baldessari
E, Casciani CU. Radiofrequency
fistulectomy vs. diathermic
fistulotomy for submucosal fistulas:
a randomized trial. European review
for medical and pharmacological
sciences. 2004;8(3):111-6.
16. Jain BK, Vaibhaw K, Garg PK,
Gupta S, Mohanty D. Comparison of
a fistulectomy and a fistulotomy with
marsupialization in the management
of a simple anal fistula: a randomized,
controlled pilot trial. Journal of the
Korean Society of Coloproctology.
2012;28(2):78-82.
17. Chalya PL, Mabula JB. Fistulectomy
versus f ist ulotomy with
marsupialisation in the treatment
of low fistula-in- ano: a prospective
randomized controlled trial Tanzania journal of health research.
2013;15(3):193-8.
18. Nhsn. Centre for Disease Control
(CDC). Procedure Associated
Module:SSI. January, 2019.
19. Mohammad Adnan Nazeer RS,
Mansab Ali, Zain Noor Ahmed. Better
Option for the Patients of Low Fistula
in Ano: Fistulectomy or Fistulotomy.
Pakistan Journal of Medical & Health
Sciences 2012;6(4).
20. ZB K. Fistulotomy Versus
Fistulectomy As a Primary Treatment
of Low Fistula in Ano. Iraqi Postgrad
Med J. 2012;11(4).