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.

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

References

  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).
Iranian Journal of Colorectal Research
Volume 11, Issue 1
March 2023
Pages 33-38

Files

Share

How to cite

Statistics