A Study of Techniques in the Management of Simple Fistula in Ano
Journal Title: Saudi Journal of Medicine - Year 2018, Vol 3, Issue 6
Abstract
Abstract:Fistula in Ano is a simple anorectal condition, however, has the potential to cause high morbidity. The usual line of surgical treatment for simple fistula in ano includes fistulotomy with marsupialization and fistulectomy. The present study was aimed to determine the overall outcomes after treatment of patients with fistulotomy with marsupialization and fistulectomy and compare the results in terms of post-operative complications and recurrences. Methods: The study involved 70 patients diagnosed with simple fistula in ano. Patients with morbid medical conditions and those diagnosed with complex fistulas were excluded from the study. The Clinical examination included perineal inspection, palpation, digital rectal examination and proctoscopic evaluation. The patients were then randomly divided into two groups. The group I patients underwent fistulectomy and the group II underwent fistulotomy with marsupialization. The patients were operated under general or regional anesthesia. The anorectal examination was done to verify the findings of the clinical examination. The patency of the tract was checked using the probe to the external opening. Seventy patients diagnosed with simple anal fistula were involved in the study. The mean distance of external fistula opening in group I was 2.6 ± 0.54 cms and the mean distance in group II was 2.5 ± 1.05. The duration of symptoms in group I and group II was 7.60 ± 2.9 and 8.85 ± 3.2 weeks respectively. The mean duration of surgery in group I was 12.5 ± 2.2, was 9.95 ± 1.25 in group II. Post-operative healing of the wounds was earlier in group II 4.06 ± 0.95 as compared to group I 5.15 ± 2.5. The mean VAS score was calculated on the 3rd postoperative day in both the group of patients. In group I the mean VAS score was 2.25 and the mean VAS score in Group II was 2.25. No patient in the study developed the wound infection and none had other complications. Conclusions: Within the limitations of the present study it can be concluded that fistulotomy with marsupialization and fistulectomy are equally effective in terms of the outcomes of treatment of simple fistula in ano. Although fistulectomy requires longer post-operative healing and the mean VAS scores were higher in the fistulectomy group then compared to fistulotomy group. No recurrence and occurrences of complications were noted in both the groups. Keywords: simple fistula in ano, Fistulotomy with marsupialization, Fistulectomy.
Authors and Affiliations
Jayaram Adepu, Shailaja Adepu
Keywords
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