title: Fistulotomy versus fistulectomy for simple fistula in ano: a retrospective cohort study.
abstract: OBJECTIVE
  To compare fistulotomy with fistulectomy for wound healing, duration of surgery, post-operative pain, incontinence and recurrence in patients with fistula in ano.
  
  
  METHODS
  This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of adults who had undergone fistulotomy/fistulectomy for simple fistula in ano from January 2007 to August 2012. Data collection was done in August 2013 using questionnaire and telephonic interviews. Outcome variables like duration of wound healing, recurrence, incontinence, duration of surgery and post-operative pain were compared in both the groups. SPSS 19 was used for data analysis.
  
  
  RESULTS
  Of the 192 cases, there were 96(50%) in each group. The mean age was 40.51 years (range: 21-72 years) in the fistulotomy group and 41.14 years (range: 21-66 years) in the fistulectomy group (p=0.66). Both groups were comparable for baseline demographic variables. The median duration of wound healing was shorter in the fistulotomy group 15 days (Interquartile range: 7-20 days) compared to the fistulectomy group 30 days (Interquartile range: 15-42 days) (p<0.001). The incidence of recurrence was comparable in fistulotomy vs. fistulectomy (3[3.12%] vs. 4[4.16%]; p=0.70). The incidence of incontinence was higher in fistulotomy compared to fistulectomy (5[5.3%] vs. 12[12.5%]; p=0.07). The severity of incontinence was also compared but the difference was insignificant (p=0.06). The median duration of surgery was significantly shorter in fistulotomy group 17 minutes (Interquartile range: 12-25 minutes) compared to fistulectomy group 25 minutes Interquartile range: 20-35 minutes (p<0.001). The median post-operative pain in the surgical day care unit and at the first follow-up in clinic was zero for both groups.
  
  
  CONCLUSIONS
  Fistulotomy yielded better results than fistulectomy since it significantly decreased the duration of wound healing and duration of surgery without increasing the incidence of recurrence, incontinence and post-operative pain.
authors.affiliation: Patel Hospital, Karachi.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.affiliation: The Aga Khan University Hospital, Karachi.
authors.forename: Fareed Ahmed
authors.initials: FA
authors.lastname: Shaikh
authors.affiliation: The Aga Khan University Hospital, Karachi.
authors.forename: Tabish
authors.initials: T
authors.lastname: Chawla
authors.affiliation: The Aga Khan University Hospital, Karachi.
authors.forename: Batool Urooj
authors.initials: BU
authors.lastname: Rajput
authors.affiliation: The Aga Khan University Hospital, Karachi.
authors.forename: Noman
authors.initials: N
authors.lastname: Shahzad
authors.affiliation: The Aga Khan University Hospital, Karachi.
authors.forename: Sumaiya
authors.initials: S
authors.lastname: Ansari
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012003:Rectal Fistula / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Fistula in ano, Fistulotomy, Fistulectomy, Incontinence, Recurrence.  