A COMPARATIVE STUDY BETWEEN FISTULECTOMY AND FISTULOTOMY WITH MARSUPIALIZATION OF TRACT IN A SERIES OF CASES OF SIMPLE PERIANAL FISTULA

Fistula in ano is a hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. It is nearly always caused by a previous anorectal abscess following infection of anal glands but can also develop secondary to Crohn's disease, anal ssures, anorectal carcinoma, radiation therapy, tuberculosis, actinomycosis, chlamydial infections and trauma.(1) The mainstay of treatment of stula-in-ano is eradication of sepsis with preservation of anorectal function. Conventional surgical options for a low stula-inano include a stulotomy and a stulectomy. In stulotomy the tract is laid open, curetted and then allowed to heal by secondary intention. Recent studies have shown that marsupialisation of the stulotomy wounds can reduce the healing time further(5,6) A stulectomy involves complete excision of the stulous tract, thereby eliminating the risk of missing secondary tracts and providing complete tissue. However, this method might result in anal sphincter impairment resulting into anal incontinence. Although major incontinence is rarely seen, minor incontinence may be apparent in upto 24%.(7) This study is aim as a comparison between the two modality and their relative effectiveness in the management of simple perianal stula. Methodology- Prior permission and approval from the ethics committee will be obtained, and an informed written consent to participate in the study will be taken from all the patients. Demographic data of each patient will be recorded including relevant clinical examination ndings and ndings of conventional radiological imaging. In our study,a total Results- of 60 cases of simple perianal stula were randomly divided into two surgical management groups of 30 each: Fistulotomy with marsuapilazation and Fistulectomy. Patients were asked to follow up after 1 week, 1 and 3 months, and 1 year. In the postoperative period following points were observed: operative time, hospital stay, healing time, post-operative anal incontinence and recurrence. Following observations weremade during the study: 1. Mean age of the study group was 43.75 years with no difference between the two treatment groups (p-0.44). 2. Overall male preponderance was seen in the study group with 91.7% males to 8.3% females with no difference between study groups with respect to gender distribution (p-1.0). 3. Most common presenting complaint was discharge (95%), swelling (80%) and pain (70%) in both the groups. 4. No difference was observed between study groups with respect to presenting complaints (p>0.05). 5. Mean duration of symptoms was 7.4 months with no difference between study groups with respect to duration of symptoms (p-0.71). 6. Mean duration of operation was signicantly less in cases operated with stulotomy technique as compared to stulectomy (31.98 vs 40.32 mins; p<0.05). 7. Mean hospital stay was signicantly less in cases operated with stulotomy technique as compared to stulectomy (1.69 vs 2.91 days; p<0.05). 8. Mean post-operative pain as measured by VAS on day 1 was signicantly less in cases operated with stulotomy technique as compared to stulectomy (4.41 vs 5.94; p<0.05). 9. Mean time for complete healing was signicantly less in cases operated with stulotomy technique as compared to stulectomy (5.66 vs 7.91 weeks; p<0.05). 10. Wound infection was reported in 2 (6.7%) cases each while anal incontinence was reported in 4 cases of stulectomy as compared to none in stulotomy group (p-0.02). 11. At 12 months follow up, recurrence was reported in 2 (3.3%) and 1 (1.7%) case operated by stulotomy and stulectomy group respectively. The difference in recurrence rate was statistically non-signicant (p-1.0). Conclusion- Present study concludes that Fistulotomy with marsuapialization of tract procedure is effective and preferred sphincter saving technique for stula-in-ano. Fistulotomy has several advantages over stulectomy which include shorter operative time, less postoperative pain, shorter hospital stay, less incidence of incontinence and faster wound healing which is expected to translate to early resumption of normal activities. The recurrence rate was comparable between the groups.