A descriptive analysis of management of fistula-in-ano
Keywords:Fistula in ano, Fistulectomy, Fistulotomy, Seton placement, Comparison
Background:A fistula-in-ano is an abnormal hollow tract that is lined with granulation tissue and which have a primary opening inside the anal canal and a secondary opening in the perianal skin. 90% of the cases, the origin is from crypto glandular infection. Leads to ano rectal abscess and chronic infection causes fistulae in ano. Various techniques have been described for management of fistula in ano but there are risk of recurrence and incontinence.
The objective of this study was to know the usefulness of investigative procedures in early and accurate diagnosis of fistula in ano. And to study the efficacy of different modalities of surgical approach with reference to post-operative hospital stay and complications like pain, bleeding and sphincter in continence and outcome in respect to persistence/recurrence of fistulae.
Methods: A total of 50 patients with clinically diagnosed fistula in ano were included in the study. All patients were subjected to surgical intervention. The study was conducted at V.S. hospital between June 2007 to November 2009. Follow up of the patients obtained up to 1 year.
Results:Commonest age of presentation in our series was 20-30 years. Males were more affected as compared to females. Low level fistula is more common and was seen in 66% cases where as 34%patients had high level fistula. Patients with Seton placement procedure require longer post-operative hospital stay (14.2 days) as compared to other two surgical procedures. Incidences of pain, bleeding and incontinence were more in Fistulectomy as compared to Fistulotomy. But recurrences were found in 4 (8%) in Fistulotomy while not a single case of recurrence was reported in other two surgical modalities.
Conclusions:Fistulotomy has a higher recurrence rate than fistulectomy. But fistulotomy may be preferred for low anal fistulas as it is associated with less chances of incontinence and has significantly less incidence of post-operative complications and is associated with less hospital stay duration.