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Comparative Study of Fistula in ANO Management by Primary Closure and Open Wound Method

Anita Kandi, Associate Professor, H 21, Tirupati Supreme Enclave, Jalan Nagar Aurangabad- 431002. , Manoj Morea , Anita Kandib , Sarojini Jadhavc , A.N. Beedkarb

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New Indian Journal of Surgery 8(3):p 340-345, Jul-Sep 2017. | DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8317.7

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Abstract

Introduction: Fistula in ano is one of the most common benign anorectal disorder associated with appreciable morbidity and inconvenience to the patient. The chronicity of its symptoms makes an otherwise healthy and active person lose their earning capacity, with lowered self-confidence. These are difficult to treat as there is no satisfactory treatment procedure available which can manage these fistulas with a high success rate and minimal risk of incontinence. Open Fistulectomy, though considered as the standard treatment for fistula in ano, fistulectomy with primary closure has the merits of short hospital stay for patients, early wound healing, lowers costs and is a safe procedure.

Aim and Objectives: To study the outcome of wound closure over nonclosure of wound after fistulectomy in cases of fistula in ano and to compare the pain, wound healing, postoperative hospital stay, and recurrence. Material and Methods: The present study was a randomized prospective study of 41 cases of fistula in ano presenting at surgical OPD of the tertiary care center. Out of 41 cases, 28 cases were managed by fistulectomy and 13 cases by fistulectomy primary closure during the period of Dec 2012 to June 2015.

Results: In the present study, the male 31(75.60%) to female 10(24.39%) ratio was 3:1. In majority of the cases 17(41.45%) the cause of fistula was spontaneous rupture or inadequately drained or treated perianal abscess. The main presenting symptoms were discharge, swelling and pain. In the present study, patients those who had undergone fistulectomy with primary closure had a mean pain score of 4.3 on day one and 9.8 in patients with lying open of wound. In primary closure group all the 13 patients were discharged from hospital in less than 10 days. The time taken for complete wound healing by fistulectomy with primary closure in 13 cases was less than 3 weeks.

Conclusion: It was concluded that primary closure is a better alternative in the surgical management of fistula in ano, considering the benefits of less postoperative pain, early healing, early discharge, early return to normal activity, cost effective and less recurrence above the nonclosure method.

 

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8317.7

Keywords

Fistula; Ppen wound; Primary closure; Fistulectomy; Anorectal. 

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