Comparison of various techniques in the management of fistula in ano

Introduction: Fistula in ano is the benign anorectal condition, but became a major problem for surgeons to cure the disease. For proper treatment of fistula in ano, a thorough knowledge of Anorectal anatomy and etiopathogenesis of the anorectal abscess is required. More than 90% cases of perianal abscess and anal fistulas occur due to cryptoglandular infections in the intersphincteric plane. Less than 10% occurs due to the complications of Crohn's disease, malignancy, Tuberculosis, and Radiation Exposure. The aim of the study: To study the different modalities of treatment for fistula in ano (Fistulotomy/ Fistulectomy/ Fibrin Glue Injection/ LIFT procedure). Materials and methods: Patients who met inclusion and exclusion criteria for the study selected and all patients discussed the nature of the disease and possible complications (recurrence, anal incontinence, and anal stricture) expected after surgery was explained. Written consent for the study and surgery was obtained. In proforma, thorough history, signs and symptoms, we identified internal opening and external opening by thorough digital rectal examination and proctoscopic examination under the adequate light were noted. Results: In our study, out of those 15 cases of Fistulectomy, 4 cases developed intraoperative bleeding, 3 cases developed sphincter injury and 3 cases had prolonged surgery more than 1 hour. Of 10 cases with Fistulotomy, 3patients developed intraoperative bleeding, 2 developed sphincter injury and 2cases had prolonged surgery more than 1 hour. Cases proceeded with Fibrin Glue Injection did not develop any obvious intraoperative complication. Conclusion: Fistulectomy has a moderate degree of intraoperative and postoperative complications with a moderate chance for stricture and incontinence and less chance for recurrence. Moreover few cases required second sitting for the completion of treatment.