A Comperative study on the efficacy of ksharsutra, fistulectomy and Ligation of intersphincteric fistula tract (LIFT) procedure in the management of fistula in ano.

Abstract

Abstract Background Fistula in ano is always a troublesome condition for both the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient time. There is no gold standard treatment modality till date documented in the literature for complex fistula in ano. Material and methods We enrolled 60 consecutive adult patients attending surgical out patient department of tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in Ligation of Intersphincteric fistula tract, fistulectomy and Ksharsutra group were respectively recruited. The main outcomes were post-operative recurrence and morbidity measured in terms of postoperative pain, postoperative bleeding and pus discharge and post operative incontinence. Results The result of the study were analysed after 6 months of follow-up, 2 patients (10%) had a recurrence in Ligation of Intersphincteric fistula tract procedure group and 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however, the differences in the recurrence were not statistically significant, the mean Visual analogue score for pain after 24 hours as well as after 48 hours were statistically significant in Ligation of Intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score was also significant in the Ligation of Intersphincteric fistula tract versus Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of Intersphincteric fistula tract procedure. Post operative morbidity was statistically significant between Ligation of Intersphincteric fistula tract versus Ksharsutra and Ligation of Intersphincteric fistula tract versus Fistulectomy. Conclusion Ligation of Intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure, although recurrence was less compared to other procedures it was statistically not significant.