Management of fistula-in-ano; a common clinical problem

ABSTRACT

Study design A prospective study of 54 patients [age ranging from 18-54 years] operated for perianal fistula. Place First Surgical Unit Nishtar Hospital Multan. Duration January 2000 to July 2001. To determine the incidence of low or high anal fistula, recurrence rate following surgery and effect of surgery as well as effect of previous procedures on the incontinence. Material and methods: The fifty four patients [54] were subdivided into two groups' i.e. low and high anal fistulae and were operated by laying open technique [fistulotomy] for low fistulae and by two-stage fistulotomy, seton "cut-through technique and Re-routing of the tract for high fistulae. Patients were followed to see the incidence of recurrence, effect of surgery on continence as well as effect of previous surgery on continence. Overall recurrence was only 4.44% for low fistulae and 11.11% for high fistula in-ano. Minor incontinence was observed only following surgery for high variety. No such complication occurred in low variety. Low fistulae can be laid open with minimal loss of sphincter muscle but as for as the high variety is concerned it is safer to place a seton or stage the procedure