A comparative study of fistulotomy and fistulectomy in management of simple fistula in ano

Abstract

Background: Fistula in ano is one of the commonest benign anorectal condition encountered during the day today practice. There are different treatment modalities available for the management of anal fistula. These include fistulotomy, fistulectomy, LIFT, seton placement, advancement flaps and use of biological agents like fibrin glue. In this prospective randomized clinical study, we have studied the outcomes after fistulotomy and fistulectomy in patients with simple low-lying fistula.

Methods: Total 84 patients with simple low-lying fistula were randomized into two groups of fistulotomy and fistulectomy (42 patients each). The intraoperative and postoperative findings noted, and the results are compared. The results are analyzed using statistical tests like student’s t test and chi square test.

Results: The mean duration of surgery in fistulotomy group was 28.6min and that of fistulectomy group was 31.7 min. The difference in duration of surgery is statistically not significant (p>0.05). The median duration of wound healing was shorter in the fistulotomy group (12 days) compared to the fistulectomy group (21 days) and the difference is statistically highly significant (p<0.001). The incidence of incontinence in fistulotomy group observed in 5 cases compared to single case in fistulectomy group. This difference is again statistically significant. Recurrence observed in one case from both the groups each within 6 months post-op period.

Conclusions: The results of fistulotomy and fistulectomy are comparable with respect to duration of surgery, postoperative pain and recurrence rate. The postoperative wound healing is faster in fistulotomy; while incontinence is also higher in fistulotomy group.