Marsupialization for simple fistula in ano

ABSTRACT

To compare the post-operative course and the outcome of marsupialized and open wounds in the patients who underwent either fistulotomy or fistulectomy for simple fistula in ano. Comparative study. Department of General Surgery Jinnah Postgraduate Medical Center Karachi, from December 2011 to May 2012. Fifty patients with simple anal fistula were included in this study. They were divided into two groups. Fistulous tracts were managed by using a fistulectomy or fistulotomy alone [group A] while a fistulectomy or fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were postoperative bleeding, postoperative pain, wound infection, anal incontinence and recurrence. Postoperative wounds in group B healed earlier in comparison to group A wounds [4.85 +/- 1.39 weeks vs. 6.75 +/- 1.83 weeks, p = 0.035]. No significant differences existed between the operating times [28.00 +/- 6.35 minutes vs. 28.20 +/- 6.57 minutes, p = 0.925] and Visual Analogue Scale scores for postoperative pain was 3.3 +/- 1.4 in group A and 3.2 +/- 1.5 in group B. Post operative bleeding was observed for a significantly longer duration in group A than in group B [4.10 +/- 1.91 weeks vs. 2.75 +/- 1.71 weeks, p = 0.035]. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks. Marsupialization of the wound after either fistulectomy or fistulotomy for simple fistula in ano results in faster healing, less bleeding without lengthening the operative time and without increasing the infection.