A FOUR MINUTES COMBINED SURGERY OF ANAL FISTULA AND HEMORRHOIDS

Fistula-in-ano is a common problem associated with high amount of discomfort and morbidity in patients suffering from it. Surgery is one among the most trusted, preferred, and major treatment modality. Among all the surgical procedures available, majority of the clinicians recommend either fistulotomy or fistulectomy. Although both the procedures have their own complications, in the end major outcome should be good quality of life, minimal incontinence, and less recurrence rate. Fistula-in-ano seems to be a disease that affects males predominantly as evidenced in the present study population and it has been supported by multiple previous studies too. On comparing the results of operating time in both the groups, duration of fistulotomy was significantly less over fistulectomy. Possible reason for such increase in duration of operating time in fistulectomy might be due to the complex procedure and more efforts involved in removing the whole tract. Where after probing, a complete dissection of the fistula tract from surrounding tissues is required followed by closuring of internal opening and coagulation of bleeding to control homeostasis.
Postsurgical hospital stay and wound healing time was also reported to be more in patients undergoing fistulectomy over fistulotomy, due to the high postoperative pain because of more dissection around the fistula tract and the raw area left after coring. The majority of other studies also reaffirmed the same, except for the studies conducted by where the VAS score in their study patients were reported to be same in both the groups and statistically insignificant . Decrease in postsurgical hospital stay and wound healing time in fistulotomy patients over fistulectomy patients is common. It might be due to the less dissection and less surgical trauma leading to quick wound healing compared with fistulectomy patients. Such decrease in surgical trauma also leads to reduced inflammation and reduced inflammatory mediators, hence proportionally helps in decrease in postsurgical hospital stay and postoperative pain.
Results from our study population also suggests that postoperative complications such as urinary retention and bleeding were observed to be seen mostly in patients who underwent fistulectomy over fistulotomy, likely due to the increased postoperative pain and wound size. Findings from our study were in line with previous studies by showing greater patient comfort and lesser complications in fistulotomy patients compared with patients who underwent fistulectomy.
Limitations of the current study include small sample size, single institutional data, and noninclusion of patients with complex and high anal fistulae. Incontinence and recurrence data were not assessed due to many patients being lost to follow-up and noncompliance on enquiring over the telephone.
Fistulotomy yielded better results and has a slight edge over fistulectomy in terms of shorter operating time, postsurgical hospital stay, wound healing time, postoperative pain, and postoperative complications. From our study results, we can conclude that fistulotomy can be the surgical procedure of choice to treat simple low lying fistula-in-ano compared with fistulectomy. The findings of the present study need to be substantiated further by conducting multicenter, prospective randomized studies involving multiple outcome variables in larger sample sizes with longer follow-ups in different types of fistulae to reach a consensus and to establish a standard line of treatment for fistula-in-ano.