Outcome of different surgical procedures for fistula-in-ano: a single centre-based study
DOI:
https://doi.org/10.18203/2349-2902.isj20220946Keywords:
Fistula-in-ano, Fistulectomy, Seton, RecurrenceAbstract
Background: Fistula-in-ano is an abnormal communication between anal canal/rectum and perianal skin. It is considered to be chronic sequelae of cryptoglandular perianal abscess. Surgical treatment is the standard of care. However, the surgical techniques have evolved over time in order to give a satisfactory non-recurring result without jeopardising continence mechanism. Our aim was to study the feasibility and outcome of various surgical procedures done for fistula-in-ano.
Methods: This study was conducted in colorectal division of department of general surgery SKIMS Srinagar, from 2017-2019. All patients underwent a surgical procedure which was deemed feasible for a particular case. Pre-operative data and post-operative outcome/complications were studied over a mean follow up of 12 months. Final inferences were drawn after analysing the data using various statistical tools.
Results: Fistula-in-ano has male predominance (8:1), with intersphincteric fistula being the commonest type (48%) in our study. Majority of our patients underwent fistulectomy (72.5%) with or without Seton placement. Over a mean follow up of 12 months, only 19 patients (15.32%) developed recurrence. Incontinence was observed in 15 patients (12.09%). The risk of recurrence was observed to be directly related to the complexity of fistula.
Conclusions: Fistulectomy is safe and effective for low intersphincteric and trans-sphincteric fistulas with acceptable rates of recurrence. Benefit of radical excision in high fistulas with multiple secondary tracts should be carefully weighed against risk of post-operative incontinence.
Metrics
References
Parks AG, Gordon PH, Harecastle JD. A classification of fistula in ano. Br J Surg. 1976;63(1):1-12.
Russel TR. Anorectum. In: Lawrence W, eds. Current surgical diagnosis and treatment. 10th ed. Netherland: Springer; 1994.
Janugade HB, Tata NH, Ashar SM, Janugade DH, Kamboj P. A clinico-pathological study of fistula-in-ano. J Evol Med Dent Sci. 2016;5(86):6395-9.
Babu AK, Naik MB, Babu MR, Madhulikia M. Seton-as a gold standard treatment for high fistula in ano. J Evid Based Med Healthcare. 2015;2(11):1687-93.
Alamshah SM, Dorestan N, Kabiri A. Non-surgical treatment of adult fistula-in-ano. assessment of curative response to intra-tract injections of combined sodium tetra decyl sulphate, ceftazidine and metronidazole. Biomed Pharmacol J. 2016;9(2):45-9.
Janugade HB, Tata NH, Ashar SM, et al. A clinico-pathological study of fistula-in-ano. J Evolution Med Dent Sci. 2016;5(86):6395-8.
Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73(4):219-24.
Kapoor S, Kumar A, Rally S, Kapoor V, Sandhu AS. Study of Clinical Presentation and Management of Patients Presenting With Fistula-in-ano. IOSR-JDMS. 2018;17(1):39-46.
Wessam H, Al-Ozaibi L, Hadiel A. Anal fistula surgery in an outpatient setting: the Dubai experience. J Coloproctol. 2015;35(1):42-5.
Marks CG, Ritchie JK. Anal fistulas at St Mark's Hospital. Br J Surg. 1977;64(2):84- 91.
Siddharth R, Kumar GA, Sreedhar S. Clinical study of fistula in ano. J Evol Medical Dent Sci. 2015;4(86): 15082-7.
Yadu S, Toppo A. Clinical presentation and outcome of fistula in ano cases. Int Surg J. 2018;5:3006-10.
Veerendra Kumar HM, Chetan PR, Naveen PR. A Clinico-Pathological Study of Fistulain-ano. Sch J App Med Sci. 2015;3(3F):14.
Poon CM, Ng DC, Ho-Yin MC, Li RS, Leong HT. Recurrence pattern of fistula-in-ano in a Chinese population. J Gastrointestin Liver Dis. 2008;17(1):53-7.
Jordán J, Roig JV, García-Armengol J, García-Granero E, Solana A, Lledó S. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis. 2010; 12(3):254-60.
Ramachandra ML, Garg M. A comparative study in the management of fistula-in- ano using various modalities. Int Surg J. 2018;5:2223-7.
Hamel CT, Marti WR, Oertli D. Simplified placement and management of cutting setons in the treatment of trans-sphincteric anal fistula: technical note. Int J Colorectal Dis. 2004;19:354-6.
