Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial

Abstract

PurposeThis randomized clinical trial was conducted to compare a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula.MethodsForty patients with simple anal fistula were randomized into two groups. Fistulous tracts were managed by using a fistulectomy (group A) while a fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were operating time, postoperative wound size, postoperative pain, wound infection, anal incontinence, recurrence and patient satisfaction.ResultsPostoperative wounds in group B healed earlier in comparison to group A wounds (4.85 ± 1.39 weeks vs. 6.75 ± 1.83 weeks, P = 0.035). No significant differences existed between the operating times (28.00 ± 6.35 minutes vs. 28.20 ± 6.57 minutes, P = 0.925) and visual analogue scale scores for postoperative pain on the first postoperative day (4.05 ± 1.47 vs. 4.50 ± 1.32, P = 0.221) for the two groups. Postoperative wounds were larger in group A than in group B (2.07 ± 0.1.90 cm2 vs. 1.23 ± 0.87 cm2), however this difference did not reach statistical significance (P = 0.192). Wound discharge was observed for a significantly longer duration in group A than in group B (4.10 ± 1.91 weeks vs. 2.75 ± 1.71 weeks, P = 0.035). There were no differences in social and sexual activities after surgery between the patients of the two groups. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks.ConclusionIn comparison to a fistulectomy, a fistulotomy with marsupialization results in faster healing and a shorter duration of wound discharge without increasing the operating time.

Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula

“…On the other hand, some researchers reported that none of their patients developed anal incontinence [6,10,14,15].The small sample size is one of the limitations of some of these studies. Another limitation is the large number of low fistulae in both groups of patients because surgical treatment of a low fistula is unlikely to compromise continence and recurrence as recurrence is more common in high fistula.…”

“…During a fistulotomy with marsupialization, the fistula tract is laid open, so dissection of the fistula tract is not required, but several minutes are required to suture the edges of the laid-open fistula tract to the skin incision [6,10,11].…”

“…In general, the temporary anal incontinence in fistulotomy patients in previous studies is about 2% and those in fistulectomy patients is about 12% [6]. Calculation of the sample size included the number of participants to be recruited for the study using the mathematical equation.…”

“…P¹ represents the temporary anal incontinence in fistulotomy patients in previous studies = 2% and P² represents the temporary anal incontinence in fistulectomy patients in previous studies = 12% [6]. The sample size was calculated according to the equation [7].…”

“…Postoperative wound discharge was defined as a non-infected sero-sanguinous secretion coming from the open wound while complete healing of the postoperative wound was defined as full epithelialization of the wound [6]. Patient's satisfaction was measured according to occurrence of incontinence, the severity of postoperative pain, wound discharge and healing time.…”