Perioperative and early postoperative outcomes following open fistulectomy, fixcision, and fibrin glue for simple low anal fistula: a prospective observational comparative study

Abstract Simple low anal fistula is commonly managed by open fistulectomy or sphincter-preserving procedures. Although minimally invasive techniques such as Fixcision and fibrin glue aim to reduce postoperative morbidity while preserving continence, comparative prospective data remain limited. This study compared the perioperative and early postoperative outcomes of open fistulectomy, Fixcision, and fibrin glue in the management of simple low anal fistula. A prospective observational comparative study was conducted at a tertiary care teaching hospital over a 16-month period. Consecutive adult patients (18–65 years) with simple low cryptoglandular anal fistula who fulfilled the inclusion criteria were enrolled. Patients underwent open fistulectomy, Fixcision, or fibrin glue treatment according to fistula characteristics, surgeon expertise, and patient preference. The primary outcomes were recurrence and fecal incontinence. Secondary outcomes included operative time, intraoperative blood loss, postoperative wound size, and postoperative pain assessed using the Visual Analog Scale (VAS). Patients were followed for 6 months. Statistical analysis was performed using Welch’s analysis of variance (ANOVA), chi-square test, and Tukey’s post hoc test, with p < 0.05 considered statistically significant. A total of 117 patients were included, with 39 patients in each treatment group, and all completed the scheduled follow-up. Baseline demographic characteristics were comparable across the three groups ( p > 0.05). The Fixcision group demonstrated significantly shorter operative time (28.85 ± 4.81 min), lower intraoperative blood loss (19.38 ± 9.60 mL), smaller postoperative wound size (1.01 ± 0.55 cm), and lower postoperative pain scores compared with the fibrin glue and open fistulectomy groups (all p < 0.001). The mean intraoperative blood loss was 52.54 ± 21.46 mL in the fibrin glue group, 19.38 ± 9.60 mL in the Fixcision group, and 57.59 ± 48.04 mL in the open fistulectomy group. Fecal incontinence occurred only in the open fistulectomy group (5/39, 12.8%; p = 0.005). Recurrence was observed in four patients each in the fibrin glue and open fistulectomy groups, whereas no recurrence occurred in the Fixcision group; however, this difference was not statistically significant ( p = 0.117). In this prospective observational study, the Fixcision technique was associated with improved perioperative outcomes, reduced postoperative pain, and preservation of continence compared with open fistulectomy, while recurrence rates were comparable during the 6-month follow-up. Given the non-randomized study design and relatively short follow-up period, these findings should be interpreted with caution. Larger multicenter randomized controlled trials with long-term follow-up are required to confirm these results.