An Analysis Comparing Fistulotomy and Fistulectomy in the Treatment of Simple Anal Fistulas

Background: Fistulotomy and fistulectomy are common surgical procedures for treating simple anal fistulas, a condition involving abnormal connections between the anal canal and skin. This study aims to compare these two methods, focusing on key outcomes such as healing time, recurrence rates, and postoperative complications, including incontinence, to determine the most effective treatment. Methods: A simple fistula was defined as one having a single external and internal opening along with a palpable tract. Group I consisted of 25 patients who underwent fistulotomy with marsupialization, while Group II comprised 25 patients who received the fistulectomy procedure for their low-lying anal fistula. The patients were matched based on age, sex, and other physical factors. Results: The mean duration of surgery was 29.5 minutes for fistulotomy and 32.2 minutes for fistulectomy, with no statistically significant difference (p-value = 0.891). The duration of wound healing was significantly longer in the fistulectomy group (21 ± 5.5 days) compared to the fistulotomy group (12 ± 2.5 days) (p-value = 0.004). Postoperative pain, as assessed by the Visual Analogue Scale (VAS), was comparable between the two groups, with a mean VAS score of 3.8 ± 1.51 in the fistulotomy group and 3.5 ± 2.19 in the fistulectomy group (p-value = 0.217). The incidence of anal incontinence was 10% (4 cases) in the fistulotomy group and 2.5% (1 case) in the fistulectomy group, although the difference was not statistically significant (p-value = 0.191). The recurrence rate was low and similar in both groups, with 1 case (2.5%) in each group. Conclusion: Fistulotomy demonstrated shorter operative time and wound healing compared to fistulectomy in the management of simple anal fistulas. However, it was associated with a higher incidence of anal incontinence, although not statistically significant. Both procedures exhibited low recurrence rates. The choice between fistulotomy and fistulectomy should be individualized based on patient factors and fistula characteristics.