SPHINCTER CUTTING AND PRESERVING SURGERIES FOR COMPLEX FISTULA IN ANO: A COMPARATIVE STUDY AT A TERTIARY CARE CENTRE IN NORTH INDIA

Abstract

INTRODUCTION: Anal stula represents an important aspect of colorectal practice, being a distressing condition for the patient and sometimes a challenge for the surgeon. Successful surgical management of anal stulas requires accurate preoperative assessment of the course of the primary stulous tract and the site of any secondary extension or abscess. Fistula-in-ano has various types of clinical presentations. With time newer techniques have also evolved. Here we comparing the various treating modalities by classifying them as sphincter preserving and sphincter cutting surgeries. AIMS AND OBJECTIVES : To compare the outcome, duration of wound healing, recurrence rate, and complications after sphincter preserving and sphincter cutting surgeries. MATERIAL AND METHODS: A total 100 patients were taken up for the study after ethical clearance and proper informed consent. Group A (n=50) patients were selected for sphincter preserving surgeries (VAAFT+FILAC+LIFT, VAAFT+FILAC, LIFT). Group B (n=50) patients were taken up for sphincter cutting procedures (stulectomy and stulotomy). Simple fistulas, and those associated with tuberculosis, IBD, carcinomas, or with perianal injury were excluded from the study. Rectovaginal and anovaginal stulas, patients with history of incontinence, or anal sphincter impairment were also excluded. RESULTS: 66% patients were males and 34% were females. (1.94:1). Mean age of patients was 41.01+12.35 between 20-70 years. Transphincteric stula was the most common type (61%, n=61) and perianal discharge was the most common presentation. (100%, n=100). Primary healing rate at 3 months in sphincter preserving surgeries was 84%, and 66% in cutting surgeries (p<0.05). Recurrence (p<0.05) was st more in cutting surgeries. Incontinence at 1 week (p<0.05) and hospital stay (p<0.05), were also more after cutting surgeries. However, there was no statistically signicant difference in the mean healing time and pain by VAS score at 48 hours. CONCLUSIONS: Sphincter preserving surgeries for complex stula in ano are better in terms of less recovery time and better healing rate, less chances of incontinence, recurrence, compared to sphincter cutting surgeries. With the advent of more sphincter sparing techniques the percentage of patients undergoing sphincter cutting techniques should continue to decrease over time.