Comparative Analysis of Fistulotomy and Fistulectomy in Managing Low Anal Fistulas

Introduction- Infected anal crypts are the most prevalent cause of an anal fistula, a pathological relationship that exists between the anal canal and perianal skin. The present study aimed to compare fistulotomy and fistulectomy in the management of low anal fistula.Method- In this prospective comparative study, a total of 90 patients of age >18 years with patients with low-lying anal fistula were included. Out of 90 patients, 45 patients underwent fistulectomy and 45 patients underwent fistulotomy as the treatment for low anal fistula and were follow-up for 3 months. Routine blood investigations like haemoglobin and complete blood count were carried out. Mean operative time, healing time, flatus incontinence, and pain was compared.Results- The mean age of the patients were 39.66±10.80 yrs with male dominancy (86.7%) in both groups. Mean Operative time of patients of Fistulectomy Group (35.31±7.48 min) was significantly higher (p=0.005) than that of Fistulotomy Group (31.33±5.39 min). In Fistulectomy Group, the mean healing time was significantly higher (28.69±4.56 days) as compared to Fistulotomy Group (24.87±4.79 days) (p<0.001). The VAS score was significantly higher in Fistulectomy Group as compared to Fistulotomy Group (p<0.001). However, differences in complaints of Flatus incontinence among patients of the above two groups were not found to be significant at any of the follow up (p>0.05). There was no case of recurrence in either of the two groups.Conclusion- Fistulotomy was found to be a better option for the management of low anal fistula patients having benefits of lower surgical duration, early healing, and lower complications.