COMPARISON BETWEEN CONVENTIONAL AND SPHINCTER-SAVING PROCEDURE (INCLUDING LASERS) IN TREATMENT OF FISTULA-IN-ANO – A PROSPECTIVE, DOUBLE ARM, SINGLE CENTRE, INDIAN STUDY

Background: Sphincter-saving procedures for anal fistula have been seldom assessed compared to conventional procedures. This study addressed this research need gap with respect to outcomes, incontinence, and recurrence rate. The prospective, compar Methodology: ative, single-center study included patients with history of fistula-in-ano between the age group of 18–60 years of coming to surgical OPD or ward. All patients were subjected to the usual standardized pre-operative and post-operative protocol. The assessment of Cleveland Clinic Florida Fecal incontinence score (CCF-FI) and pain visual analogue score (VAS) was done to evaluate patient outcomes post-surgery. 100 fistula-in-ano cases were Results: enrolled and randomized in conventionalsurgery group and the sphincter-saving-surgery groups (50 patients each). Baseline patient characteristics were comparable (p>0.05). Most patients in both, the conventional fistulectomy group (64%) and sphincter saving group (62%) were having trans-sphincteric type of anal fistula. At all time-points, the mean CCF-FI scores for gas, use of pad for stools, lifestyle alteration, as well as the total CCF-FI scores were comparable between study groups (p>0.05). Mean pain VAS score was significantly lower in the sphincter saving group at 2-weeks and 4-weeks post-surgery (p<0.05) versus conventional fistulectomy group. 1 patient in conventional fistulectomy group and 3 patients in sphincter-saving group experienced recurrence. Based on fecal incontinence Conclusion: status, no difference in outcomes was noted between the conventional and sphincter-saving surgery groups. However, the postoperative pain was noted to be significantly lower in the sphincter saving surgery group. Recurrence rates were low and comparable between both surgery groups.