Is Fistulotomy with Marsipulization more Effective than Fistulectomy alone for Low Fistula in Ano?

Aslam, Danish; Zaheer, Farhan; Siddiqui, Sarush Ahmed; Moosa, Foad Ali; Naseer, Shafaq; Arsalan, Rabia; Osama, Muhammed

doi:10.1055/s-0041-1736642

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Journal of Coloproctology (Rio de Janeiro)

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Original Article • J. Coloproctol. (Rio J.) 41 (04) • Oct-Dec 2021 • https://doi.org/10.1055/s-0041-1736642 copy

Is Fistulotomy with Marsipulization more Effective than Fistulectomy alone for Low Fistula in Ano?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Fistula in ano is a very common perianal condition seen in outpatient departments. Fistulotomy and fistulectomy are two conventional options of surgery. The present study is designed to observe wound healing time and mean postoperative pain score in the comparison of outcome of the fistulectomy to fistulotomy with marsupialization.

Methods

This prospective randomized trial was conducted in the surgical department of the Civil Hospital Karachi for a period of 12 months, in which 60 patients with low anal fistula were divided into 2 groups. Thirty patients in group A were treated with fistulectomy, and 30 in group B were treated with fistulotomy with marsupialization. The postoperative pain severity was assessed after 24 hrs through a visual analogue scale and on weekly and fortnightly follow-ups for 6 weeks. Wound healing was assessed by clinical examination on weekly and fortnightly follow-ups for 6 weeks to estimate the mean healing time.

Results

The mean pain score was significantly lower in group B in comparison to group A (3.6±1.99 versus 2.40±1.52; p=0.01). The mean wound healing time was shorter in group B in comparison to group A (4.23±0.77 versus 5.80±0.41 weeks; p=0.0005).

Conclusion

Fistulotomy with marsupialization is a simple, easy, and more effective method than fistulectomy for the treatment of simple perianal fistula.

Keywords:
fistula in ano; fistulotomy with marsupialization; fistulectomy

Statistics		Group AN = 30	Group BN = 30
Mean		36.40	38.00
Stadard deviation		7.26	13.29
95% confidence interval for mean	Lower bound	33.69	33.04
95% confidence interval for mean	Upper bound	39.11	42.96

Age groups (Years)	Outcome	Groups	n	Mean	Standard deviation	95% confidence interval for mean		P-value
Age groups (Years)	Outcome	Groups	n	Mean	Standard deviation	Lower bound	Upper bound	P-value
≤ 40	Pain	Group A	26	3.85	1.99	3.04	4.65	0.013
	Pain	Group B	12	2.00	2.08	0.67	3.33	0.013
	Healing time	Group A	26	5.85	0.36	5.70	5.99	0.0005
	Healing time	Group B	12	4.50	0.52	4.17	4.83	0.0005
> 40	Pain	Group A	4	2.00	1.15	0.16	3.84	0.242
	Pain	Group B	18	2.67	0.97	2.18	3.15	0.242
	Healing time	Group A	4	5.50	0.57	4.58	6.42	0.0005
	Healing time	Group B	18	4.06	0.87	3.62	4.49	0.0005

Gender	Outcome	Groups	n	Mean	Standard deviation	95% confidence interval for mean		P-value
Gender	Outcome	Groups	n	Mean	Standard deviation	Lower bound	Upper bound	P-value
Male	Pain	Group A	22	3.55	1.92	2.69	4.40	0.012
	Pain	Group B	28	2.29	1.51	1.70	2.87	0.012
	Healing time	Group A	22	5.82	0.39	5.64	5.99	0.0005
	Healing time	Group B	28	4.25	0.79	3.94	4.56	0.0005
Female	Pain	Group A	8	3.75	2.31	1.81	5.69	0.887
	Pain	Group B	2	4.00	0.00	4.00	4.00	0.887
	Healing time	Group A	8	5.75	0.46	5.36	6.14	0.001
	Healing time	Group B	2	4.00	0.00	4.00	4.00	0.001

DM	Outcome	Groups	n	Mean	Standard deviation	95% confidence interval for mean		P-value
DM	Outcome	Groups	n	Mean	Standard deviation	Lower bound	Upper bound	P-value
Yes	Pain	Group A	2	3.00	0.00	3.00	3.00	0.842
	Pain	Group B	4	4.00	0.00	4.00	4.00	0.842
	Healing time	Group A	2	5.00	0.00	5.00	5.00	0.633
	Healing time	Group B	4	4.50	1.29	2.45	6.55	0.633
No	Pain	Group A	28	3.64	2.06	2.84	4.44	0.004
	Pain	Group B	26	2.15	1.49	1.55	2.76	0.004
	Healing time	Group A	28	5.86	0.36	5.72	6.00	0.0005
	Healing time	Group B	26	4.19	0.69	3.91	4.47	0.0005

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[1] Address for correspondence Sarush Ahmed Siddiqui, MBBS, Department: General Surgery, Institute/University/Hospital: Dow University of Health Sciences, Saddar, Karachi, Pakistan (e-mail: siddiquisarush@gmail.com).