Clinical study of various modalities of treatment for fistula in ano at a tertiary care hospital

Abstract

Background: Despite the ease of diagnosis, establishing a cure is problematic as many patients tend to let their disease nag them rather than treatment. Also, due to site of this disease many patients delay the treatment. Objectives was to study the various etiologies of fistula in ano, to study the different modes of clinical presentations of these fistulae-in-ano, efficacy of different modalities of surgical approach with reference to recurrence of fistulae.Methods: Hospital based cross sectional descriptive study was carried out among 81 eligible patients of fistula in ano. Local Examination, Per Rectal Examination, Proctoscopy was done to assess the external opening, internal opening and fistula tract. Patients were advised Fistulogram and sent to Department of radiology on outpatient basis for the same. Patients with fistulography report were admitted and surgical treatment was planned according to the fistulography report. Appropriate surgery was planned. Specimens were sent to histopathology.Results: Commonest age of presentation was between 30-40 years. Males were more commonly affected. Swelling in perineal region was commonest mode of presentation. Fistula with only one opening was around 85.18%. Anteriorly situated fistula was around 14.81%. Low level fistula was more common. Majority of patients i.e. 74.07% underwent fistulectomy. 9.87% patients underwent fistulotomy. 16.04% patients underwent setonthresd placement. Three Patients developed recurrence.Conclusions: Fistulotomy is associated with slightly high recurrence but low chances of anal incontinence as compared to fistulectomy.

Clinical study and management of fistula in Ano

“…In present study, male patient is 74%, i.e. >50%, similar result were observed studies by Tated S.P et al [3] 82.71%, Alexander N et al [13] 82.5%, Jebakumar A et al [4] 80%. Most common etiological factor is perianal sepsis following Crypto glandular infection 62%, similar result was observed by Alexander N et al [13] .…”

“…Most common etiological factor is perianal sepsis following Crypto glandular infection 62%, similar result was observed by Alexander N et al [13] . In present study most prevalent symptom is pain 32%, in contrast Tated S.P et al [3] 97.53% presented with swelling in perineal region, Sushma R et al [15] 96% presented with perianal discharge. We found that simple fistula (76%) is more common, similar result observed by Alexander N et al [13] 85%.…”

“…58.33%, similar result observed by Alexander N et al [13] . In present study most common procedure done is fistulotomy 56%, in contrast Tated S.P et al [3] 74.07% patients were treated by Fistulectomy, Jebakumar A et al [4] Fistulectomy surgery had done in 68%. It is found that complications are seen in 32% cases of fistula in Ano surgery, out of which most common complication is recurrence 26%.…”

“…If the right kind of surgery is not performed, the disease tends to recur. It can also recur due to negligence in post-operative care [3] . The prevalence of nonspecific anal fistulae has been estimated to be 8.6 to 10/100,000 of the population per year, with a male to female ratio of 1.8:1 [4] .…”