A comprehensive study of fistula in ano

Background: A fistula-in-ano is an abnormal hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Treatment of fistula-in-ano remains challenging. Surgery is the treatment of choice, with the goals of draining infection, eradicating the fistulous tract, and avoiding persistent or recurrent disease. Aim: This study was intended to investigate the factors determining the course of fistula in ano and its recurrence of patients with fistula in ano came to Govt. Stanley Hospital for 1 year. Materials and methods: 45 patients were selected who were diagnosed as fistula in ano admitted in Govt. Stanley Hospital during June 2015 to May 2016. The anatomy and type of fistula was detected by MRI. Patients underwent definitive treatment. Data regarding the objectives of the study were collected and outcomes of the treatment evaluated by following up the patient for 6 months. Results: Majority of patients (82%) belonged to 31 -60 years of age. Male: Female ratio was 4:1. Most of the fistulas were low anal 41 (91%). About 34 (76%) of external openings were posterior. Fistulectomy was performed in 31 cases, fistulotomy for 10 cases, seton for 4 cases and the operated wound healed in a range of 2 weeks to 8 weeks. Delayed healing was associated with complex fistulas, intersphincteric and transphincteric fistula takes longer time to heal about 4 to 5 weeks (P = 0.007). Fistula of tubercular etiology took minimum 3 weeks to heal (P =0.047). 13 % of cases showed recurrence. Transphincteric fistulas had recurrence rate of 33%. Fistulas with lateral openings had recurrence rate of 67%. Conclusion: Fistulectomy is the commonest and best procedure to get rid of the infective pathology. Fistula in ano has a well recognised incidence of recurrence after surgical treatment.