Management of Fistula-In-Ano: A local Experience

Objective: To evaluate short and long-term outcomes of complex fistula surgery. Patients and Methods: This cross-sectional study was conducted on all patients, both male and female admitted to General Surgery Department of PIMS, Islamabad who underwent surgery for fistula-in-ano from 1st January 2010 to 31st December 2015. A total of 65 patients, who underwent surgery for fistula-in-ano in the hospital were included in this study. They were assessed by case review supplemented by OPD follow up and telephonic interview when necessary. Results: A total of 65 cases of fistula-in-ano were operated in the surgical unit of the hospital. Out of the total patients, 27 patients were operated once, 29 patients were operated twice and 9 patients had surgery three times. Almost about half of the patients (45 %) had trans sphincteric complex fistula with secondary tract identified in 40% cases, 16 % cases with intra sphincteric, 36% cases with extra sphincteric, 3% case with horseshoe shaped and 5% with a combination of two. In 45 % of the cases, excision of primary and secondary tracts were done with loose seton placement while preserving the sphincter complex. About 36 % cases had excision of the tract while in horseshoe cases fistulotomy was done. In 4 % of cases primary excision of the tract and repair of the sphincter complex was performed. In two patients, drainage and curettage of presacral abscess was done. We made colostomy in one patient after 4th recurrence while one patient was having colostomy before operation that was operated 6 times for fistula. No incontinence was reported for solid and liquid, while 12.3 % cases had transient flatus incontinence, 9.2 % cases presented post-operative bleeding in which 4 % of patients settled with pressure dressing while 5.2 % required control of bleeding under GA. Conclusion: Majority of the complex fistula in-ano treated by primary fistulotomy or stage fistulotomy with a loose seton are followed by good clinical and functional result