Title: Comparison and Evaluation of the Outcome of Fistulotomy Vs Fistulectomy Technique in Treatment of Low Fistula in Ano
Authors: Atul Kumar Vyas, Amit Katlana, Abhinav Rathi, Prateek Porwal, Rahul Jain, Praneeth Etta
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.114
Abstract
Background: Fistula in ano is common surgical condition that is being treated by different surgical modalities. Aim of the study was to compare and evaluate the outcome of fistulotomy and fistulectomy technique in treatment of low fistula in ano.
Material and Method: This prospective study was conducted in department of surgery Index Medical College Hospital and research centre, indore from June ' 14 to July '16. This study included 75 patients of low fistula in ano admitted during the study period .out of these 38 patients underwent fistulotomy (group A ) and 37 patients underwent fistulectomy (group B). The two techniques were compared in terms of healing time, post operative pain, hospital stay, complication, recurrence and outcome.
Result: The average age of study group was 45.2 years with male: female ratio 7.3:1. post operative pain was 2.16 ± 1.02 days for group A (fistulotomy) and 5.95 ± 3.00 days for group B (fistulectomy).
4(Four) patients of group A (10.52%) had wound infection while 15 patients of group B (40.52%) had wound infection.
post operative wounds in group A healed earlier in comparision to group B wounds (28.55 ± 5.717 vs 48.54 ± 12.43 days , P = 0.0001).The mean hospital stay of group A was 2.86 ± 1.78 days , while for group B was 4.32 ± 2.22 days .No incidence of anal incontinence in both groups. Recurrence developed in 2 patients out of 38 (5.3%) of fistulotomy and 7 patients out of 37 (18.9%) following fistulectomy.
Conclusion: Fistulotomy can be recommended as a standard surgical procedure in the treatment of low anal fistula for the merits of early wound healing, less post operative pain, lower rates of wound infection, early hospital discharge and lesser incidence of recurrence in comparison to that of fistulectomy.
Keywords: Fistulotomy, Fistulectomy, Low Anal Fistula.
References
1. Bacon.H.E, Stuart.T.Ross, and Porfiro Mayo Recro : Proctology, J.B. Lippincort Co. PP, 88-108, 1956.
2. Buie. L.A : Practical Proctology, 2nd Edn. 1960.
3. Khurana, C., Saronwala, K. C. and Gupta, S. P.: Primary skin grafting after fistulectomy in the treatment of fistula in ano. Amer. J. Proctol., 23: 139-152, 1972.
4. Deshpande, P. J., Pathak, S. N., Sharma, B. N. and Singh, L. M.: Treatment of fistula in ano by Kshara Sutra. J. Res. Ind. Med., 2: 131-139, 1968.
5. Deshpande, P. J. Pathak and Sharma, K. R.: Non-operative ambulatory treatment of fistula in ano by a new technique. Review and follow-up of 200 cases. Amer. J. Proctol., 24: 49-60, 1973.
6. Gabriel, W. B'.: "The Principles and Practice of Rectal Surgery." 5th Edition. H. K. Lewis and Co. Ltd., London, 1963, pp. 6, 268, 289-313.
7. Kumar.R, Gupta.A.K, and Mathur.D : Anal fistula : A nonoperative method of treatment. A report of 100 cases. Indian journal of Surgery, 49 ; 239-243, july 1987.
8. Agarwal D, Arora D, Avasthi A and Singhal S .Scholars Journal of Applied Medical Sciences Sch. J. App. Med. Sci., 2014; 2(1B):202-204 (SJAMS) ;ISSN 2320-6691 (Online) ISSN 2347-954X (Print)
9. Kronborg O. To lay open or excise a fistula-in-ano: a randomized trial. Br J Surg.1985;72:970. [PubMed]+
10. Athanasiadis S, Helmes C, Yazigi R, Köhler A, The direct closure of the internal fistula opening without advancement flap for transsphincteric fistulas-in-ano. Dis Colon Rectum. 2004 Jul;47(7):1174-80. Epub 2004 May 19.
11. Khurana, C., Saronwala, K. C. and Gupta, S. P.: Primary skin grafting after fistulectomy in the treatment of fistula in ano. Amer. J. Proctol., 23: 139-152, 1972
12. Imran Anwar, Zahid Niaz, Ahmad Muneeb, Khalid M Cheema, Amna Moeen. Fistulotomy a better treatment modality than Fistulectomy for low Fistulo in Ano.Ann King Edward Med Coll Apr - Jun 2003;9(2):171-2.
13. Jain BK, Vaibhaw K, Garg PK, Gupta S, Mohanty D.J Korean Soc Coloproctol. 2012 Apr; 28(2): 78–82. Published online 2012 Apr 30. doi: 10.3393/jksc.2012.28.2.78
14. Bhatti Y, Fatima S, Shaikh GS, Shaikh S. Fistulotomy versus fistulectomy in the treatment of low fistula in ano.Rawal Medical Journal,PMAR;vol36,no4;oct-dec,2011;1-8.