ABSTRACT
Objective: To assess the outcome of the surgical management of patients with complex fistula-in-ano
Study design: Case series
Place and Duration of study: Department of General surgery Jinnah Postgraduate Medical Center Ward 2 Karachi, from January 2009 to December 2012
Methodology: An analysis of patients with complex fistula-in-ano treated with different operative techniques Resultswas done. The techniques included two stage seton fistulotomy, three stage seton fistulotomy, fistulectomy with sphincter repair, drainage of supralevator abscess and colostomy. Patients were followed-up through colorectal OPD with special emphasis on postoperative bleeding, healing, recurrence and fecal incontinence
Results: Out of total 123 patients with different types of anal fistulae there were 58 [47.1%] complex and 65 [52.8%] low anal fistulae. There were 105 [85.3%] males and 18 [14.6%] females. Out of 58 complex fistulae, 28 [48.2%] patients had inter-sphincteric, 12 [20.6%] transsphincteric, 10 [17.2%] suprasphincteric, 06 [10.3%] extrasphincteric and 02 [3.4%] horseshoe fistulae. Forty-one [70.6%] patients were treated with two-stage seton fistulotomy technique, 5 [8.6%] with three stage seton fistulotomy, 11 [18.9%] with fistulectomy with sphincter repair, and in 01 [1.7%] patient colostomy was made. Overall complication rate in two stage seton fistulotmy was 9.7% and 18.1% in fistulectomy with sphincter repair
Conclusion: Complex fistulae may be successfully treated by various techniques, but the two-stage seton fistulotomy technique was an effective method for this type of fistula