Comparison of Fistulotomy versus Use of 1% silver nitrate in terms of post-operative pain in low-lying perianal fistula.

Abstract

Objective: To compare the average postoperative pain in patients who received fistulotomy and those who received 1 percent silver nitrate to treat low-lying perianal fistulas. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital II (DHQ Hospital), Faisalabad. Period: 25^th February to 25^th August 2025. Methods: The qualified patients were randomly allocated into two groups. Group A was done under general anesthesia and had fistulotomy, and Group B was done with 1% of silver nitrate to be applied following curettage of the fistula tract. Visual Analog Scale (VAS) was used to evaluate postoperative pain at 12 weeks, and all analysed data were recorded on an organised proforma. Results: Group B (1% silver nitrate) had significantly lower mean pain scores (VAS: 3.37 ± 1.09) than Group A (fistulotomy) did (VAS: 4.30 ± 1.80, p = 0.019) at 12 weeks. Silver nitrate treatment was especially beneficial to younger patients, males, and those who did not have comorbidities. Conclusion: The study concludes that 1% silver nitrate is a less invasive and effective alternative to fistulotomy for the treatment of low-lying perianal fistulas, significantly reducing postoperative pain and promoting better recovery.