title: Marsupialization of fistulotomy and fistulectomy wounds improves healing and decreases bleeding: a randomized controlled trial.
abstract: BACKGROUND
  Marsupialization of anal fistulotomy/fistulectomy wound leaves less raw unepithelialized tissue. The suture results in a more rapid healing and is likely to reduce the risk of bleeding but at the cost of an increased pain and infection. The aim of this prospective study was to compare the outcomes of marsupialization and open wound.
  
  
  METHODS
  Forty-six consecutive patients with anal fistulae were recruited in a randomized controlled trial. Fistula tracks were treated by fistulotomy and/or fistulectomy. The resulting wounds were marsupialized to the skin edges with locking continuous absorbable sutures (M group) or left open (O group). The clinical outcome was then evaluated. The intra-operative effect of the suture on wound size was recorded as well as the postoperative pain using a 0-10 visual analogue scale (VAS) and the occurrence of both wound bleeding and infection.
  
  
  RESULTS
  Twenty-two patients were randomized to the M group and 24 to the O group. There were no differences in the age, sex and fistula type between the groups. Mean follow-up times were 10.5 and 13.8 months, respectively. No significant difference was observed in postoperative pain, the VAS being 3.5 +/- 1.5 in the M group and 3.4 +/- 1.6 in the O group at 12 h (mean +/- s.e.m.; n.s). The marsupialization nearly halved the size of the wound intra-operatively from an area of 1749 +/- 66 mm2 to 819 +/- 38 mm2 (P < 0.001), which subsequently decreased to 217 +/- 15 mm2 after 4 weeks (P < 0.01). No significant reduction of wound size was observed in the O group (from 1171 +/- 31 mm2 to 543 +/- 19; n.s). Bleeding occurred less frequently in M group than in O group (36%vs 46%, P < 0.05), whereas the difference in the postoperative sepsis rate was not significant, being 14% in M vs 21% in the O group. Three reinterventions were needed in both groups due to wound sepsis.
  
  
  CONCLUSIONS
  Marsupialization after fistulotomy/fistulectomy significantly reduces the size of the wound and the risk of bleeding, without increasing postoperative pain and sepsis.
authors.affiliation: Coloproctology Unit, Villa Flaminia Hospital, Rome, Italy. ucpclub@virgilio.it
authors.forename: M
authors.initials: M
authors.lastname: Pescatori
authors.forename: S M
authors.initials: SM
authors.lastname: Ayabaca
authors.forename: D
authors.initials: D
authors.lastname: Cafaro
authors.forename: A
authors.initials: A
authors.lastname: Iannello
authors.forename: S
authors.initials: S
authors.lastname: Magrini
mesh_terms: D000328:Adult; D003107:Colorectal Surgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D012003:Rectal Fistula; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing