A Comparative Study of Fistulotomy and Fistulectomy in the Management of Low Lying Fistula in Ano in Patients Presenting to Tertiary Care Centre

Background and Objectives: Fistula - in - ano (FIA) is an abnormal connection between the anal canal and perineal skin. Its treatment is controversial, typically involving either fistulotomy or fistulectomy. This study aims to compare these two procedures in managing low anal fistulas, focusing on procedure duration, postoperative pain (VAS scale), complete healing time, and recurrence. Methods: A prospective comparative study was conducted at Saraswathi Institute Of Medical Sciences, Hapur, UP from August 2022 to July 2024. Patients with low FIA were divided into two groups: Fistulectomy (fx) and Fistulotomy (fo). Procedure duration was recorded for both groups. Postoperative pain was assessed using the Visual Analog Scale (VAS) on Days 1, 3, and 7. Patients were monitored for complete wound healing time and recurrence at 3 months post - surgery. Results: The mean procedure duration was 7.36 minutes for fistulectomy and 3.80 minutes for fistulotomy, a statistically significant difference (p<0.001). Mean postoperative VAS scores for fistulectomy were 7.36 (Day 1), 5.76 (Day 3), and 4.60 (Day 7), while for fistulotomy, they were 6.24, 4.72, and 3.68, respectively, all significant (p<0.001). Complete healing time was 5.62 weeks for fistulectomy and 4.78 weeks for fistulotomy (p=0.006). No recurrence was noted in fistulectomy group and 3 recurrent cases in fistulotomy group within 3 months. Conclusions: No single procedure is definitively superior for low anal fistulas. Fistulotomy is quicker and simpler, with less postoperative pain and faster healing. However, fistulectomy shows a lower recurrence rate, suggesting the need for larger studies to confirm these findings.