Compare the surgical outcome of Fistulectomy and Mucoal advancement flap in perianal fistula.

Abstract

Objective: To compare the fistulectomy with mucosal advancement flap in treatment of perianal fistula in terms of mean hospital stay, frequency of anal incontinence and wound healing time. Study Design: Randomized Control Trial. Setting: Surgical OPD, DHQ and Allied Hospital, Faisalabad. Period: 1^st March 2019 to 28 February 2020. Methods: Conducted on 120 (60 in each group) patients with fistula in ano presenting. Sampling technique was Non probability consecutive sampling. All the Patient age ranges from 20-55 years of either gender having perianal fistula which are low lying fistulas and with single external opening are included in study. Patients having perianal abscess, pilonidal sinus, Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis) or with history of tuberculosis, HIV disease, Complex high lying fistulas with multiple external openings are excluded. Results: In our study, group A underwent fistulectomy while on group B we perform mucosal advancement flap. About 56.67%(n=34) in Group A and 50%(n=30) in Group B were between 20-40 years of age while 43.33%(n=26) in Group A and 50%(n=30) in Group B were between 41-55 years of age, mean+SD was calculated as 38.78+9.07 years and 40.12+8.89 years respectively. According to gender division 86.67%(n=52) in Group A and 78.33%(n=47) in Group B were male while 13.33%(n=8) in Group A and 21.67%(n=13) in Group B were females, mean hospital stay was calculated as 93.93+4.56 hours in Group A and 107.95+4.66 hours in Group B, p value was calculated as 0.0001 showing a significant difference between the two groups. Comparison of anal incontinence in both groups was done showing that 13.33% (n=8) in Group A and 23.33%(n=14) in Group B had anal incontinence, p value was calculated as 0.15. At one month postoperative follow-up only 4 patient (6.7%) in group A showed complete wound healing while in group B 28 patients out of 60(46.6%)showed complete wound healing, P value was calculated as 0.00167 showing a significant difference while there is no significant difference in incidence of early post-operative complications. Conclusion: We concluded that hospital stay was significantly decreased in cases with fistulectomy when compared with MAF while there was no significant difference regarding anal incontinence in both groups.