A study on clinicopathology of fistula in ano

Abstract

Background: Perianal fistula is a common surgical problem which poses great discomfort to patients and causes prolonged morbidity when improperly managed or developed complications. Its management protocols are ill defined, and the efficacy of newer treatment modalities are not well established. The aim of the study was to study the clinicopathology of Perianal fistula and its prognostic factors.Methods: This was a prospective study conducted at the Department of General Surgery, Rajiv Gandhi Government General Hospital between August 2014 and July 2015. Purposive sampling method was used select patients with fistula in ano. After obtaining informed consent, patient details were collected in pre-tested structured questionnaire. Data entry and analysis were done using SPSS software.Results: Males between thirty and fifty years were the most affected population. Most of the patients had no co-morbidities while Diabetes Mellitus was the prevalent co-morbid factor, seen especially in the elderly. MRI fistulogram was the investigation of choice. Fistulotomy was the preferred procedure. Recurrence of fistula was an unavoidable morbidity.Conclusions: Proper preoperative evaluation which includes MRI fistulogram and planning the treatment is essential to prevent complications. Fistulotomy is the preferred treatment especially in patients with trans-sphincteric fistula and those with evidence of infection or secondary tract. The prognosis, if properly managed is very good, so proper management protocols need to be established.

Clinical study of fistula in ano with special reference to its surgical management

“…This incidence is slightly elevated in comparision to other Indian study like Khanna et al who cited an incidence of 14.7%. 12 The rate of frequency cited above may indicate that there is a increase in incidence which may be attributed to patient's growing awareness about the disease and about their health.…”

To study the management of Fistula-In-Ano: An experience at tertiary care centre in rural area, can achieve acceptable fistula care

“…Internal opening was identified in (26.53%). Phinehas E et al observed internal opening only 45.33%, of patients [20] . On fistulogram, tract was identified (55.11%) and not identified (44.89%) & compared intra-op findings with length of tract, fistulogram report correct in (22.44%).…”

“…Saadeldin Ahmed idris et al observed anal discharge 99%, pain 57.5%, Itching 43.4%, Bleeding 3.8%, Constipation (14.2%) [19] . Phinehas E et al stated Perianal discharge 56.67%, external opening seen in all (100%) [20] . Van Koperen PJ et al described small, painful anal swelling with intermittent sero-purulent discharge [6] .…”

“…Yadu S et al found25% anteriorly, 76% posteriorly situated [17] . Phinehas E et al observed external opening posterior to transverse line in (66.67%) [20] . Helena Tabry et al found external opening is near the anal canal posterior to transverse line with short length then most likely, it is simple fistula [2] .…”

“…Saadeldin Ahmed idris et al described I & D done in 8.5%, fistulotomy / fistulectomy (6.6%) [19] . Phinehas E et al described fistulectomy done in 25%, fistulotomy in 68%, Seton 7% [20] . Helena Tabry et al stated during fistulotomy the fistula tract is curated to remove infected or necrotic tissues [2] .…”