Fistula in Ano-An Entity with Enigmas: what to do and what not to do

Abstract

Background: Fistula-in-ano is the leading complication of perineal sepsis. Usually, a fistula has an external opening, a track, and an internal opening. Following infection and/or an abscess,External opening may appear acutely or with delayed appearance in a chronic manner. Management protocol for a fistula includesassessment of the extent of fistulous track &its relation to the anal sphincter muscle, control of infection,and finally, surgical treatment of the fistula & follow up. The principles in management of anal fistula aredrainage of infection or necrotic tissue, closure of internal opening of fistula tract, and removal of fistulous tract with preservation of sphincter function. The objectives of the studyis to compare the per operative and post-operative complications, mean hospital stay in the treatment of fistula in ano with treatment options like fistulotomy, fistulectomy, and setons. Methods: This is a comparative, prospective study of 60 patients who presented with their complaints to the Surgerical Outpatient department and who were admitted under the Department of General Surgery, P K Das Institute of Medical Sciences, Vaniamkulum, Palakkad, Kerala. Patients who met the inclusion criteria were included in this clinical study. Of the 60 patients selected for the sudy, 20 patients were surgically treated by fistulectomy, 20 by seton, 20 by fistulotomy over a period of 2 years. Results: Most common age of presentation is 21-30 years and more common in males then females (M:F= 2.3:1 ). Most common per operative complication was bleeding which was seen more in patients undergoing fistulectomy. 36% of the patients wound healed in less than 1 week, 22% of patients wound healed in 1 to 2 weeks,15% of patients wound healed in 2 to 3 weeks, 9% of the patients wound healed in 3 to 4 weeks. Conclusion: Fistula in ano is cured by various methods of surgery and higher antibiotics, local antibiotics with good post-operative wound management, like sitz bath without closing the wound and frequent/regular follow up.Seton technique is better compare to fistulectomy and which is better than fistulotomy.