Publication:

Comparison of fistulectomy and fistulotomy in low variety perianal fistula

Background Fistula in ano is an abnormal tunnel between the anal canal and perianal skin, often causing pain and discharge. This study aims to compare the outcomes of fistulectomy and fistulotomy in patients with low variety perianal fistula.

Methods This cross-sectional, descriptive study was conducted at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from April to September 2012. Fifty patients with low variety perianal fistula underwent fistulectomy (n=25) or fistulotomy (n=25) under spinal anesthesia, with pre- and postoperative antibiotics and analgesics. Outcomes assessed included hospital stay, wound healing, pain, workload, and cost, with weekly follow-up for six weeks.

Results Among 50 participants (mean age 40 years; fistulectomy 39, fistulotomy 41), 82% were male (M: F 5:1 versus 4:1). Most were laborers (38%), shopkeepers (26%), or farmers (18%). Prior anorectal abscesses accounted for all fistulae (spontaneous rupture 80%, incision and drainage 20%). Common complaints were discharge 96%, pain 80%, swelling 64%; purulent discharge 90%. Posterior fistulae predominated (70%). Postoperative pain scores were 8.88 versus 5.20 (p<0.001), hospital stay 4.65 versus 4.08 days (p<0.001), and wound healing 31 versus 29 days (p=0.001) for fistulectomy versus fistulotomy; 18 patients had temporary urinary retention (1 catheterized).

Conclusion Fistulotomy is the preferred treatment for low variety perianal fistula, offering faster healing, shorter hospital stays and lower patient and healthcare burden compared to fistulectomy.