Outcomes of Modified Fistulectomy Under Local Anesthesia for Anal Fistula: A Prospective Observational Study from Iraq

Background: Fistula in ano (FIA) is a chronic condition involving an epithelialized tract between the anal canal and perianal skin, typically requiring surgery. Conventional techniques often require general anesthesia and hospitalization, with risks of recurrence and incontinence. Objective: To assess outcomes of a modified fistulectomy performed under local anesthesia in an outpatient setting. Methods: A prospective observational study was conducted at a private surgical clinic in Wasit, Iraq, from January 2018 to December 2024. Of 500 enrolled patients, 373 met the inclusion criteria and underwent a standardized modified fistulectomy by a single surgeon. Exclusions included refusal to participate, incomplete follow-up, and fistulae related to injury, Crohn’s disease, or malignancy. The protocol included preoperative imaging, local anesthesia, and marsupialization. Follow-up lasted at least 6 months, with most patients observed for 12 months or more. Data were analyzed using SPSS. Results: The cohort was predominantly male (91.2%), with a median age of 36 years. Simple fistulae comprised 72% of cases. Complete healing without complications occurred in 86% of patients. Recurrence was observed in 1%, with no cases of fecal incontinence. Pain or discomfort occurred in 6%, and delayed healing or infection in 3.5%. No significant associations were found between outcomes and age, gender, or fistula type. Conclusions: Modified fistulectomy under local anesthesia is a safe, effective, and practical approach for treating anal fistula, with low recurrence and complication rates. It eliminates the need for general anesthesia or hospitalization, supporting its use in outpatient settings.