MRIMS Journal of Health Sciences (Jan 2018)
Ksharasutra vs. fistulectomy for fistula in ano – A Randomized Controlled Trial in East Godavari district, Andhra Pradesh, India
Abstract
Background: Anal fistula (plural fistulae), or fistula-in-ano, is a chronic abnormal communication between the epithelialized surface of the anal canal and (usually) the perianal skin. The conventional laying - open will lead to division of most of the anal sphincter muscles resulting in incontinence, thus making anal fistulae, especially high anal fistulae difficult to treat. Objective: This study attempts to compare the two techniques, fistulectomy and Ksharasutra in the treatment of fistula-in-ano. Methods: A Randomized Controlled study with 168 patients of fistula in ano was conducted in a tertiary care hospital, Rajahmundry. All those with low anal fistulae were included in the study. Chi square test was used to compare categorical variables. Independent t-test was used to analyze the difference among continuous variables. A P-value of < 0.05 is considered statistically significant and 0.000 is very highly statistically significant. Results: Most of the patients 84 (50%) belonged to 30 - 39 years. Mean age was 34.6 years in fistulectomy patients and 36.7 years in ksharasutra treatment group. Most of them 131 (78%) were males. Majority of the patient had single external opening 148 (88%). Most of the external openings were located postero-lateral 109 (65%). MRI showed that 128 (76%) cases had inter- sphincteric fistulae, 35 (21%) trans-sphincteric fistulae and 5 (3%) sub mucosal fistulae. Ksharasutra required significantly (p = 0.000) lesser duration for surgery, experienced significantly (P = 0.000) less pain post-operatively. The mean duration of healing was significantly (p 0.000) more (34.95 ± 1.8 days) in Ksharasutra group. Ksharasutra group had significantly (P 0.000) few days “off-work”. Ksharasutra required significantly (P 0.000) lesser duration of hospital stay. Cost incurred in rupees was comparatively lesser Rs.1200 for Ksharasutra. The recurrence rate at 1 year was 2 (2.38%) with ksharasutra which is significantly (P 0.000) lower compared to 6 (7.14%) with fistulectomy. Only four cases (4.76%) of incontinence were seen, of which, one (1.2%) case of major incontinence occurred in fistulectomy group. Conclusion: Ksharasutra is a better alternative to fistulectomy in the treatment of fistula in ano, in terms of duration of surgery, pain, hospital stay, cost, post-operative discharge, time for healing, days of absence from work and post-operative complications such as incontinence and recurrence.
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