Fistulectomy v/s Fistulotomy with marsupilization: A comparative study between the two in management of simple anal fistula.

Dr. Rahul Gupta; Dr. Devesh Bhomia; Dr. Neha Bhomia

Volume : IX, Issue : II, February - 2020

Fistulectomy v/s Fistulotomy with marsupilization: A comparative study between the two in management of simple anal fistula.

Dr. Rahul Gupta, Dr. Devesh Bhomia, Dr. Neha Bhomia

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. It is one of the most common benign ano rectal condition encountered on routine practice. The different treatment modalities available for the management of anal fistula include fistulotomy, fistulectomy, LIFT, seton placement, advancement flaps and use of biological agents like fiin glue. Low anal fistulae have been mainly treated by fistulotomy with good results. In this prospective clinical study, we have noted the outcomes after fistulectomy & fistulotomy with marsupialization in patients with simple low–lying fistula. Methods: Total 90 patients with simple low–lying fistula were randomized into two groups– A (Fistulectomy–50) & B (Fistulotomy with marsupialization–40). The intraoperative and postoperative findings noted, and the results were compared. Results: Postoperative wound healing was earlier in group B (4.30+0.64 weeks) than in group A (7.38 +1.83 weeks). This difference in healing time reached statistical significance with a p value of 0.0003. Postoperative wounds ceased to ooze earlier in group B than in group A (2.23 wk + 0.65 vs 4.81 weeks + 0.79) p value: 0.0002. No difference in the operating times was noted between the two groups. Wound size was smaller in Group B (1.96 cm2+ 0.52) than Group A (3.38 cm2± 0.46). No difference in pain score was noted in both the groups. No infection was noted in both the groups. Conclusions: In comparison to a fistulectomy, a fistulotomy with marsupialization results in faster healing and a shorter duration of wound discharge without increasing the operating time.