Objectives: To compare the importance of fistulectomy against fistulotomy regarding preventing recurrence of fistula in ano.
Patients and Methods: The study is based on a sample of 272patients with fistula in ano treated at the Royal Medical Services Hospitals (Prince Rashid Hospital) during the period of February 2002 till February 2012, the patients were evaluated and followed up by a reported post operative notes in the clinic .They were divided into two groups: the first group who underwent fistulectomy, and the second group who underwent fistulotomy.post operative pain, hospital stay and recurrence rate were assessed.
The follow up time was from one month to 24 months with a mean of 12 months, depending upon the availability of the patients and their files. Follow up in the clinic included both subjective and objective ways.
Results: Out of 272 patients underwent surgery, 146 patients were in the first group whom underwent fistulectomy, and the second group was 126 patients whom underwent fistulotomy. There were 190 males with (16-60 years) a mean age of 38 years. And 82 females with (17-41) a mean age of 29 years (Table 1.), they were all of the same type of fistula (low type of fistula in ano); other types of fistulas were excluded. The recurrence rate was 8 out of 146 (6%) in the 1st group while was 13 out of 126 (10%) in the 2nd group (Table 2).
Twenty five patients of fistulectomy (1st) group (17%) complained of pain postoperatively on first post operative day, while complaint of postoperative pain was noted in thirty three patients of fistulotomy group (26%) –(Table 3). No one suffered incontinence in both groups. The post operative hospital stay period in fistulectomy group was 2 days ranged between 1 to 4 days, and that in fistulotomy group was 3 days ranging from 1 to 5 days (Table 3). The time needed for healing in case of fistulectomy with or without primary closure was about 3 weeks, while in fistulotomy needs about 4 weeks (Table 4.), with resolution of symptoms and morbidity of surgery. Over 220 (81%) patients were discharged within 3 days of surgery.
Conclusion: Low fistula in ano can be satisfactorily and easily managed by surgery. Data obtained shows marked difference in the incidence of recurrence between fistulectomy with primary or secondary repair and fistulotomy.
The recurrence rate and healing time following fistulectomy is better than fistulotomy, there have been no complaints of problems with continence, also this results in great economy in hospital stay, less post operative pain and less morbidity with better long term results to the patients.
Key words: Low type fistula, fistulectomy, fecal incontinence.
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