A Clinical Review of Fistula-in-ano

ABSTRACT

This study is a clinical review of 154 patients with fistula-in-ano, which were treated at the Department of General Surgery of Ewha Womans University Hospital from January, 1993 to December, 1996. The male to female ratio was 41, and the prevalent of groups were in the 3rd and 4th decade. The symptoms were anal discharge in 123 cases(79.8%), pain in 21 cases (13.6%), palpable mass in 9 cases(5.8%). 53.8% of the patients showed a duration of symtoms which were within 6 mouths. The previous or combined anal diseases were anal abscess in 62.4%, postfistulectomy in 29.0%, hemorrhoid in 4.3%, and anal fissure in 1.2%. The histopathologic etiologies were chronic non-specific inflammation in 94.8%, and tuberculosis in 3.2%. 38.8% of the patients showed an external openings in the anterior midline, 25.9% in the posterior midline, 13.0% in the left lateral, and 10.4% in the right lateral portion of the anus. In 84.4% of the patients, the interval opening was identified. The intersphincteric type was the most common. The operative procedures included fistulotomy with lay open in 129 cases(83.8%), fistulotomy with seton in 16 cases(10.4%), and fistulectomy in 8 cases(5.2%). The days of hospital stay were mostly within 14 days. The main postoperative complications were urinary retention and reccurance, which were identified in 4.6% each of the patients. The acuracy and the predictive value of fistulography, a method of identification of the internal openings showed an accuracy of 73%, the predictive value of positive tests was 95% and that of the negative test was 30%.