Ass. Lect. Ahmed mahmoud abdelkader mahmoud ghalab :: Publications:

Background: Fistula-in-ano is one of the most common benign anal conditions in daily surgical practice. It is defined as an epithelialized abnormal tract connecting two surfaces, usually the rectal mucosa and perianal skin. Fistula-in-ano usually results from an anorectal abscess which bursts spontaneously or after inadequate surgery (1).The mainstay of treatment of fistula-in-ano is eradication of sepsis with preservation of anorectal function. Conventional surgical options for a low fistula-in-ano include a fistulotomy, fistulotomy with marsupialization and a fistulectomy. Aim: to evaluate the outcomes of fistulotomy with marsupialization in comparison with fistulotomy alone in treatment of a simple low anal fistula. . Methods: Thirty patients (30) with low,non recurrent perianal fistulae were randomly assigned as follow: Group(A)- Fifteen (15) patients were randomized to the lay open (LO) group in which minimal amount of perianal skin on both sides of the incised tract was excised. This was designed to prevent premature skin healing before granulation from the depth of the wound was completed. Group (B): Fifteen (15) patients were randomized to the marsupialization group (MS) group in which the anoderm and the skin at the wound edges were sutured to the sides of the laid open fistula tract with interrupted poly galactin braided suture (Vicryl 2/0). -Patients were followed up12 weeks after operation. The measured outcomes include:Wound infection ,Wound healing duration ,Postoperative pain ,postoperative blood loss ,Recurrence and anal incontinence. Results: There was high statistical difference between marsupialization technique after fistulotomy and fistulotomy alone, as regarding wound infection, wound healing duration, postoperative pain, postoperative blood loss, recurrence and anal incontinence. Conclusion: The study shows that marsupialization of perianal fistulae is superior to fistulotomy alone, as regarding wound infection, wound healing duration, post operative pain ,post operative blood loss, recurrence and anal incontinence .