A COMPARATIVE STUDY OF THE OUTCOME OF OPEN FISTULECTOMY VERSUS FISTULECTOMY WITH PRIMARY CLOSURE IN LOW LEVEL FISTULA IN ANO

Abstract

Introduction: Fistula-in-ano remains a surgical treatment challenge in colorectal practice due to high recurrence rates and the risk of postoperative wound infection and incontinence. It most commonly follows an anorectal sepsis and is one of the most common benign ano-rectal disorder. The main principle of management of anal stula are closure of internal opening of stula tract, drainage of infection or necrotic tissue, eradication of stulous tract with preservation of sphincter function. Open Fistulectomy, though considered as the standard treatment for stula-in-ano, stulectomy with primary closure has certain merits. Aim and Objectives: To compare the effectiveness of the procedure between open fistulectomy and fistulectomy with primary closure method. Materials and Methods: Study design- A prospective randomized and comparative study, period October 2019 to April 2021(18 months). Study Area-Ramakrishna Mission Seva Pratishthan hospital, Kolkata, West Bengal. Inclusion criteria- All patients with low anal stula, of any age and sex. Exclusion criteria- Patients with diabetes mellitus, immunosuppression, tuberculosis, inammatory bowel disease, active sepsis, recurrent stula, high anal stula or patients not willing to enter the study. Results: Our study showed, in open stulectomy, the mean duration of wound healing was [31.3667± 4.2221 days], mean stay in hospital after surgery was [13.5000± 2.4176 days], mean post operative VAS was [4.4667± .7761], compared to primary closure surgery patients which was [9.0333± .7184], [7.3333± 1.1547 days] and [1.9000± .9229] respectively which were statistically signicant (p<0.0001). Post operative incontinence was found in 10.0% patients of open stulectomy and 3.3% patients of primary suturing which was statistically insignicant (p=0.3006). Post operative urinary retention was found in 33.3% patients of open stulectomy and 26.7% patients of primary suturing. It was not statistically signicant (p=0.5731). 6.7% patients of primary suturing had post operative cut through of sutures. Summary and Conclusion: We concluded that stulectomy with primary closure can be used as a primary and effective measure in treatment of low stula-in-ano.