An observational study on etiopathogenesis and management in Fistula-in-Ano

Abstract

Background: Anal fistulas are abnormal communication between the anal canal and perianal skin or result of anal gland obstruction, with secondary abscess formation and external rupture of the abscess perineum. Fistula in ano rarely heals spontaneously and requires surgical therapy to achieve a cure. Surgical techniques like fistulotomy, fistulectomy, primary closure after excision of tract and staged operations have rendered the postoperative period uneventful, short and steep fall in recurrence rate.Methods: In this retrospective study, 30 patients were selected with diagnoses of fistula in ano admitted in New Civil hospital, Surat, Gujarat during April 2016 to April 2017. Patient underwent definitive treatment. Data related to the objectives of the study were collected from case sheets retrieved from hospital records with permission of competent hospital authority and after approval from ethical committee of institute. Appropriate surgical management were performed. Postoperative findings were noted.Results: Maximum number of patients were in the age group of 30 to 60 years. There were 27 (90%) male patients, 3 (10%) female patients indicating that the disease is more common in male with a ratio of male to female is 9:1. In the study the commonest symptom is discharge in all patients with pruritus in 2 (6.66%) patients and Pain or perineal discomfort in 20 (66.6%) of patients. The commonest sign is presence of external opening in all cases and internal opening in 21 (70%) of patients. Regarding the procedures performed, the majority of the patients 20 patients (66.66%) underwent fistulectomy, while 06 patients (20%) underwent fistulotomy. Seton was tried in 04 patients (13.33%) out of which in 02 patients associated fistulectomy was done.Conclusions: We concluded that the previously burst opened or surgically drained perianal abscess is the main aetiological factor for fistula-in-ano. Operative morbidity is usually low. There is a male preference for the disease and the fistulectomy remains the commonest procedure in our study series.