PriMera Scientific Medicine and Public Health (ISSN: 2833-5627)

Case Study

Volume 3 Issue 3

Relative Comparisons in Surgical Outcomes of Fistulectomy and Fistulotomy in Low Variety Perianal Fistula

Chishti Tanhar Bakth Choudhury*, Mohammad Al Mamun and Md Shahadat Hossain

August 25, 2023

DOI : 10.56831/PSMPH-03-085

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Abstract

Background: Fistula in Ano is a chronic abnormal communication runs outward from anorectal lumen (int opening) to an external opening on the skin of perineum or buttock. History of ischiorectal, perianal abscess is the main hindering reason. Tuberculosis, IBD (Crohns or ulcerative proctocolitis), trauma can also lead to development of anal fistula. Sometimes termed as nonspecific, idiopathic or cryptoglandular and intersphincteric anal gland infection. chronic discharge, occasional pain and blood staining, foul smelling, cloths soiling and disturbance in religious purposes for muslims are the reasons to operate.

Objectives: To specify duration of healing in low variety fistula in Ano after surgery and staying time in Hospitals. Other concomitant issues in perioperative period.

Methodology: This cross sectional study was carried out in Bangabandhu sheikh Mujib Medical university from April to Sept 2012. Total 50 patients were selected as study population whom were admitted with low anal fistula and internal opening is below anorectal ring. Horse shoe, high variety fistula, associated disease (TB, IBD), malignancy were excluded from study population. Patient were grouped in A and B. A for Fistulectomy and B for fistulotomy. 25 patients in Group A, 25 patients in Group B. surgery was conducted by spinal anaesthesia and preoperatively 1 gm ceftriaxone and 1 bottle (500 gm) metronidazole given in each patient. Patients were discharged in 2nd post operative day with some guidelines and education of treatment maneuver. First follow up after 7 days and 2nd follw up after 4 wks.

Results: Total 50 patients admitted in BSMMU surgery Department and grouped in A (Fistulectomy) and B (Fistulotomy). Age range was 20-70 yrs and male are suffered more than female. low socioeconomic groups are presented more with history of anorectal abscess. Mean hospital stay was more in Fistulectomy with raised pain score than fistulotomy.

Conclusion: Anal fistula is a common cause of chronic pain and anal nuisance. Delineation of anal anatomy and identification of fistulas tract is important to prevent recurrence. Fistulotomy patient has less post operative pain with less hospital stay than fistulectomy in low variety anal fistula.

Keywords: Fistulectomy; Fistulotomy; Low variety fistula

References

    1. Peter J Lunniss. “The anus and anal canal”. In: Norman S.Williams, Christopher J.K.Bulstrode, P.Ronan O’connell, Eds. Bailey and love's, Short practice of surgery, 25th edition, 2008; Edward Arnold (Publishers) Ltd (2008): 1262-1266.
    2. Seow-Choen F and Nicholls RJ. “Anal fistula”. Br J Surg 79 (1992): 197-205.
    3. Isbister WH. “Fistula in ano: a surgical audit”. Int J Colorectal Dis 10 (1995): 94-6.
    4. Parks AG, Gordon PH and Hardcastle JD. “A classification of fistula in ano”. Br J Surg 63 (1976): 1-12.
    5. DGG Bartolo, JMS Johnstone and RF Rintoul. “Operations on the Rectum and Anal canal”. In:R.F.Rintoul, Editor. Farquharson’s Textbook of Operative Surgery, 8th Edition, 1995 International Student Edition (1995): 515-16.
    6. Mark L Welton., et al. “Current Diagnosis and Treatment”. Surgery, 13th Edition 713-14.
    7. Gupta PJ. “Radiofrequency fistulotomy in anal fistula. An alternative to conventional surgical fistulotomy”. Medicina (Kaunas) 39 (2003): 996-8.
    8. Robert JC Sterle and Kenneth Campbell. “Disorders of the anal canal”. Sir Alfred Cuschieri, Robert J.C.Steile, Abdool Rahim Moosa, Eds. Essential Surgical Practice, Vol-2, 4th Edition 640.
    9. Fielding Garrison. “An introducing to History of Medicine”. 14 (1917): 365-7.
    10. Lai CK, Wong J and Ong GB. “Anorectal suppuration: a review of 606 patients”. Southeast Asian J Surg 6 (1983): 22-6.
    11. Wong FM, Hsu H and Yang SC. “Anal fistula and abscess”. Review of 518 cases. Southeast Asian J Surg 3 (1980): 9-15.
    12. Sainio P. “Fistula-in-ano in a defined population”. Incidence and epidemiological aspects. Ann Chir Ggnaecol 73 (1984): 219-24.
    13. Gordon PH and Nivatvongs S. “Principles and practice of surgery for the colon, rectum, and anus (2nd edn)”. Quality Medical Pub.: St. Louis, Mo (1999): 1455.
    14. Goodsall DH and Miles WE. “Diseases of the anus and rectum”. Longmans, Green: London 2 (1900).
    15. Erhan Y., et al. “A case of large mucinous adenocarcinoma arising in a long-standing fistula-in-ano”. Dig Surg 20.1 (2003): 69-71.
    16. Choen S., et al. “Comparison between anal endosonography and digital examination in the evaluation of anal fistulae”. Br J Surg 78.4 (1991): 445-447.
    17. Navarro-Luna A., et al. “Ultrasound study of anal fistulas with hydrogen peroxide enhancement”. Dis Colon Rectum 47.1 (2004): 108-114.
    18. Buchanan GN., et al. “Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula-inano”. Dis Colon Rectum 48.1 (2005): 141-147.
    19. Lunniss PJ., et al. “Magnetic resonance imaging of fistula-in-ano”. Dis Colon Rectum 37.7 (1994): 708-718.
    20. Buchanan GN., et al. “Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard”. Radiology 233.3 (2004): 674-681.
    21. Garcia-Aguilar J., et al. “Anal fistula surgery. Factors associated with recurrence and incontinence”. Dis Colon Rectum 39.7 (1996): 723-729.
    22. Aguilar PS., et al. “Mucosal advancement in the treatment of anal fistula”. Dis Colon Rectum 28.7 (1985): 496-498.
    23. Zimmerman DD., et al. “Anocutaneous advancement flap repair of transsphincteric fistulas”. Dis Colon Rectum 44.10 (2001): 1474-1480.
    24. Loungnarath R., et al. “Fibrin glue treatment of complex anal fistulas has low success rate”. Dis Colon Rectum 47.4 (2004): 432-436.
    25. Lindsey I., et al. “A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula”. Dis Colon Rectum 45.12 (2002): 1608-1615.
    26. Buchanan GN., et al. “Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial”. Dis Colon Rectum 46.9 (2003a): 1167-1174.
    27. Sentovich SM. “Fibrin glue for anal fistulas: long-term results”. Dis Colon Rectum 46.4 (2003): 498-502.
    28. O'Connor L., et al. “Efficacy of anal fistula plug in closure of Crohn's anorectal fistulas”. Dis Colon Rectum 49.10 (2006): 1569-1573.
    29. O Kronborg. “To lay open or excise a fistula-in-ano: a randomized trial”. In:Br J Surg 72 (1985): 970.
    30. Vasilevesky and Gordon. “Results of treatment of fistulae-in-ano”. In Dis col Rectum 28.4 (1984): 225-231.
    31. Goligher John. “Surgery of the anus rectum and colon”. London, Bailliere Tindall (1984): 179.
    32. Marks CG and Ritchie JK. “Anal fistulas at St. Mark’s Hospital”. Br J Sury 64 (1977): 84-91.
    33. Yasmeen Bhatti., et al. “Fistulotomy versus Fistulectomy in the treatment of low Fistula in ano”. Rawal Medical Journal.