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Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula

Received: 12 October 2015     Accepted: 13 October 2015     Published: 13 January 2016
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Abstract

Introduction: Anal fistulae are still negatively influencing the patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Although a number of surgical techniques have been proposed to treat this condition, there is still no single ideal technique for the treatment of this disease. Generally, fistulectomy is an adequate surgical procedure for the treatment of a simple or low transsphincteric fistula while others reported that fistulotomy continues to have excellent results. Patients and Methods: This study represented parallel prospective randomized clinical trial where 200 patients were divided randomly into two main groups; A and B. Group A patients were subjected to fistulotomy and those of group B were subjected to fistulectomy for low anal fistulae. The study included all patients having low anal fistulae complicating perianal abscesses. Patients with high fistulae and patients with multiple external openings were excluded. The primary end point was anal incontinence and the secondary end points were time off from work, postoperative pain, wound discharge, wound healing and patients’ satisfaction. Results: The mean operative time, time taken for wound discharge to cease and time taken for complete healing was significantly less in patients of group A. Regarding the occurrence of fecal incontinence, no permanent cases were reported in our series but temporary incontinence was observed in 2 patients in fistulotomy group while in fistulectomy group there were 4 patients. Therefore, the overall patient satisfaction mean values were 90.6 ± 8.87and 85.6 ± 13.2 for patients in group A and B respectively with statistically insignificant distribution. Conclusion: Fistulotomy could be used as a primary treatment of low anal fistula as being safe and simple to perform with good patient’s satisfaction as regard postoperative pain and outcome.

Published in Journal of Surgery (Volume 4, Issue 2-1)

This article belongs to the Special Issue Gastrointestinal Surgery: Recent Trends

DOI 10.11648/j.js.s.2016040201.14
Page(s) 15-19
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Low Anal Fistula, Fistulotomy, Fistulectomy, Patient’s Satisfaction

References
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[2] Kim do S. Advancement flap for the treatment of a complex anal fistula. Ann Coloproctol. 2014; 30(4): 161-2. doi: 10.3393/ac.2014.30.4.161.
[3] Ertem M, Gok H, Ozveri E, Ozben V. Application of advancement flap after loose seton placement: a modified two-stage surgical repair of a transsphincteric anal fistula. Ann Coloproctol. 2014; 30(4): 192-6.
[4] Jacob TJ, Perakath B, Keighley MR. Surgical intervention for anorectal fistula. Cochrane Database Syst Rev. 2010, 12; (5): CD006319.
[5] Hall JF, Bordeianou L, Hyman N, Read T, Bartus C, Schoetz D, Marcello PW. Outcomes After Operations for Anal Fistula: Results of a Prospective, Multicenter, Regional Study. Dis Colon Rectum. 2014; 57(11): 1304-1308.
[6] Jain BK, Vaibhaw K, Garg PK, Gupta S and Mohanty D. Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial. J Korean Soc Coloproctol. 2012; 28(2): 78–82.
[7] Saber A, Ellabban GM, Gad MA and Elsayem K. Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study. BMC Surgery 2012, 12: 22 doi: 10.1186/1471-2482-12-22.
[8] Imhoff LR, Brown JS, Creasman JM, Subak LL, Van den Eeden SK, Thom DH, Varma MG, Huang AJ. Fecal incontinence decreases sexual quality of life, but does not prevent sexual activity in women. Dis Colon Rectum. 2012; 55(10): 1059-65.
[9] Kamal ZB. Fistulotomy Versus Fistulectomy As a Primary Treatment of Low Fistula in Ano. Iraq Postgrad Med J, 2012: 11(4): 510-515.
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[14] Abu Salem OT. Fistulectomy and fistulotomy for low anal fistula. Rawal Med J.2012, 37. (4): 409-411.
[15] Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD. A randomized controlled trial of fibrin glue vs conventional treatment for anal fistula.Dis Colon Rectum. 2002; 45: 1608-15.
[16] Sahakitrungruang C, Pattana-Arun J, Khomvilai S, Tantiphlachiva K, Atittharnsakul P, Rojanasakul A. Marsupialization for simple fistula in ano: a randomized controlled trial. J Med Assoc Thai. 2011; 94(6): 699-703.
[17] Bhatti, Y, Fatima, S, Shaikh, GS. & Shaikh S. Fistulotomy versus fistulectomy in the treatment of low fistula in ano. Rawal Med J. 2011; 36: 284-286.
[18] Pescatori, M., Ayabaca, S. M., Cafaro, D., Iannello, A. & Magrini, S. Marsupialization of fistulotomy and fistulectomy wounds improve healing and decreases bleeding: a randomized controlled trial. Colorectal Diseases. 2006; 8: 11-14.
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Cite This Article
  • APA Style

    Aly Saber. (2016). Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula. Journal of Surgery, 4(2-1), 15-19. https://doi.org/10.11648/j.js.s.2016040201.14

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    ACS Style

    Aly Saber. Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula. J. Surg. 2016, 4(2-1), 15-19. doi: 10.11648/j.js.s.2016040201.14

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    AMA Style

    Aly Saber. Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula. J Surg. 2016;4(2-1):15-19. doi: 10.11648/j.js.s.2016040201.14

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  • @article{10.11648/j.js.s.2016040201.14,
      author = {Aly Saber},
      title = {Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula},
      journal = {Journal of Surgery},
      volume = {4},
      number = {2-1},
      pages = {15-19},
      doi = {10.11648/j.js.s.2016040201.14},
      url = {https://doi.org/10.11648/j.js.s.2016040201.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.s.2016040201.14},
      abstract = {Introduction: Anal fistulae are still negatively influencing the patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Although a number of surgical techniques have been proposed to treat this condition, there is still no single ideal technique for the treatment of this disease. Generally, fistulectomy is an adequate surgical procedure for the treatment of a simple or low transsphincteric fistula while others reported that fistulotomy continues to have excellent results. Patients and Methods: This study represented parallel prospective randomized clinical trial where 200 patients were divided randomly into two main groups; A and B. Group A patients were subjected to fistulotomy and those of group B were subjected to fistulectomy for low anal fistulae. The study included all patients having low anal fistulae complicating perianal abscesses. Patients with high fistulae and patients with multiple external openings were excluded. The primary end point was anal incontinence and the secondary end points were time off from work, postoperative pain, wound discharge, wound healing and patients’ satisfaction. Results: The mean operative time, time taken for wound discharge to cease and time taken for complete healing was significantly less in patients of group A. Regarding the occurrence of fecal incontinence, no permanent cases were reported in our series but temporary incontinence was observed in 2 patients in fistulotomy group while in fistulectomy group there were 4 patients. Therefore, the overall patient satisfaction mean values were 90.6 ± 8.87and 85.6 ± 13.2 for patients in group A and B respectively with statistically insignificant distribution. Conclusion: Fistulotomy could be used as a primary treatment of low anal fistula as being safe and simple to perform with good patient’s satisfaction as regard postoperative pain and outcome.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula
    AU  - Aly Saber
    Y1  - 2016/01/13
    PY  - 2016
    N1  - https://doi.org/10.11648/j.js.s.2016040201.14
    DO  - 10.11648/j.js.s.2016040201.14
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    JO  - Journal of Surgery
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    AB  - Introduction: Anal fistulae are still negatively influencing the patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Although a number of surgical techniques have been proposed to treat this condition, there is still no single ideal technique for the treatment of this disease. Generally, fistulectomy is an adequate surgical procedure for the treatment of a simple or low transsphincteric fistula while others reported that fistulotomy continues to have excellent results. Patients and Methods: This study represented parallel prospective randomized clinical trial where 200 patients were divided randomly into two main groups; A and B. Group A patients were subjected to fistulotomy and those of group B were subjected to fistulectomy for low anal fistulae. The study included all patients having low anal fistulae complicating perianal abscesses. Patients with high fistulae and patients with multiple external openings were excluded. The primary end point was anal incontinence and the secondary end points were time off from work, postoperative pain, wound discharge, wound healing and patients’ satisfaction. Results: The mean operative time, time taken for wound discharge to cease and time taken for complete healing was significantly less in patients of group A. Regarding the occurrence of fecal incontinence, no permanent cases were reported in our series but temporary incontinence was observed in 2 patients in fistulotomy group while in fistulectomy group there were 4 patients. Therefore, the overall patient satisfaction mean values were 90.6 ± 8.87and 85.6 ± 13.2 for patients in group A and B respectively with statistically insignificant distribution. Conclusion: Fistulotomy could be used as a primary treatment of low anal fistula as being safe and simple to perform with good patient’s satisfaction as regard postoperative pain and outcome.
    VL  - 4
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Author Information
  • Department of General Surgery, Port-Fouad General Hospital, Port-Fouad, Egypt

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