A Comparative Study of Fistulectomy Versus Fistulotomy with Marsupialisation for the Treatment of Low Fistula-In- Ano

ABSTRACT

Background: A fistula in ano is a pathway, lined by granulation tissue that joins deeply in the anal canal or rectum and superficially on the skin around the anus. A fistulectomy involves complete excision of the fistulous tract. Low anal fistulae have been mainly treated by fistulotomy with good results. However, Marsupialization of the fistulotomy wounds can reduce the healing time further. The purpose of this study was a randomized controlled trial that aimed to compare the fistulectomy to the fistulotomy with marsupialization in the management of simple anal fistula. Methods: This was an analytical type of study which was conducted at departments of surgery of TMMC & RC, Moradabad from September 2017 to September 2018. The patients included in the study were randomly divided into two groups. Group I included seventy patients (70) underwent for fistulectomy and group II consisted seventy patients (70) underwent for fistulotomy with marsupialisation. Results: The healing time was longer in group I (37.6 ± 11.9 day) in comparison to group II (29.8 ± 13.6 days) with a statistically significant p value (<0.05). The length hospital stay for both groups was 4.6 ± 1.4 days. Whereas, length hospital stay individually for group I and group II were 4.4 ± 1.1 days and 4.8 ± 1.7 days correspondingly with an insignificant p value (>0.05). There were significantly less postoperative pain as well as blood loss in group II patients of fistulotomy with marsupialisation in comparison of group I patients of fistulectomy. There was an insignificant difference in the extents of adverse effects of surgery on various aspects of group I and group II. Conclusion: Results of the present study suggested that there was a shorter duration of wound healing as well as less blood loss in patients of fistulotomy with marsupialisation in comparison of patients of fistulectomy. Therefore, fistulotomy with marsupialisation is recommended as a standard surgical procedure in the surgical treatment of low fistula-in-ano. However, studies on larger population and longer period of follow-up are warranted to establish fistulotomy with marsupialisation as standard surgical procedure for the treatment of low fistula-in-ano.