Fistulotomy versus fistulectomy as a treatment for low anal fistula in infants

Abstract

Objective To compare between two methods of surgical treatment for fistula-in-ano (FIA) in infants, fistulotomy and fistulectomy, and their surgical outcome and also to review the clinical presentation and diagnosis of this condition in our tertiary center.Background FIA occurring in infants is a relatively common condition. It is more common in boys than in girls, and 96% of cases occur in infants younger than 1 year. The surgical treatment options of these fistulas are fistulotomy or fistulectomy.Patients and methods In this study, between January 2010 and December 2011, 36 infants with low-type FIA were treated surgically. Eighteen infants were treated by fistulotomy (group A) and 18 were treated by fistulectomy (group B). No infant had underlying illness. All cases were subjected to the same protocol of preoperative evaluation, anesthesia, and follow-up protocol. The two techniques were compared in terms of the operative time, healing time, complications, and outcome. All were reported, analyzed, and compared.Results Male sex predominance was reported. Twentyseven infants were younger than 1 year old and the remaining patients were in their second year of life, with a mean age of 9.7 ± 4.9 months. The mean values of healing time were 21 ± 3.01 days for group A (range 17-28 days) and 26.6 ± 1.42 days for group B (range 25-30 days). There was a statistically significant difference between the two groups in both the operative time and the healing time. There was one recurrence and one granuloma in group B. One wound infection was reported in patients who underwent fistulotomy (group A). ConclusionThe treatment of FIA in infants remains controversial and it can be treated either by fistulotomy or by fistulectomy. However, there are fewer risks and shorter recovery times associated with fistulotomy as compared with fistulectomy. A future study involving nonoperative management would be required to assess other treatment options.

Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula

“…Potentially relevant RCTs identified and screened for retrieval (n = 12), RCTs excluded because they compared fistulectomy to fistulectomy with marsupalization or other procedure (Jain et al 2012 ; Chalya and Mabula 2013 ; Limongelli et al 2016 ; Pescatori et al 2006 ; Ho et al 1998 ; Toyonaga et al 2007 ). Finally, 6 RCT publications which involved 565 patients fulfilled the inclusion criteria and were included in this review (Gafar 2013 ; Nazzer et al 2012 ; Bhatti and Fatima 2011 ; Sheikh and Shukr 2015 ; Filingeri et al 2004 ; Kronborg 1985 ) (Fig. 1 ).…”

“…Operative time was only reported in three studies (Gafar 2013 ; Sheikh and Shukr 2015 ; Filingeri et al 2004 ). As statistically significant heterogeneity was evident for the outcome measure of operative time, the random effect model was used to combine the data.…”

“…Healing time was only reported in three studies (Gafar 2013 ; Sheikh and Shukr 2015 ; Filingeri et al 2004 ). Significant heterogeneity was detected (p < 0.00001, I 2 = 96 %), using the random-effect method for the meta-analysis.…”

“…Five articles reported on different complications (Gafar 2013 ; Bhatti and Fatima 2011 ; Sheikh and Shukr 2015 ; Filingeri et al 2004 ). The main complications included wound pain, wound infection and wound bleeding.…”

Neonatal and infantile fistulas: spectrum of findings on conventional contrast imaging with surgical correlation

“…Usually, perineal fistula presented in the older age group after perineal suppuration. All perineal fistulas were low and treated by fistulectomy as seen in the literature [29].…”