A case series A CLINICOPATHOLOGICAL STUDY WITH EVALUATION OF DIFFERENT OPERATIVE TECHNIQUES FOR FISTULA-IN-ANO ON PATIENTS: AN OBSERVATIONAL STUDY.

Fistula in ano case series

Abstract

Title: A CLINICOPATHOLOGICAL STUDY WITH EVALUATION OF DIFFERENT OPERATIVE TECHNIQUES FOR FISTULA-IN-ANO ON PATIENTS: AN OBSERVATIONAL STUDY.

Introduction: Fistula-in-ano form a good majority of benign treatable lesions of rectum and anal canal. Anal fistulas are considered as one of the commonest cause for a persistent seropurulent discharge that irritates the skin in the neighbourhood and causes discomfort. Anal fistulas develop secondary to perianal abscess. Complex fistula can have a characteristic of the following: multiple tracts, recurrence, pre-existing incontinence, fistula in Crohn’s disease. Most of these fistula-in-ano are easy to diagnose with a good source of light, a proctoscope, and a meticulous digital rectal examination. Managing fistula in ano is a challenge since it carries a significant recurrence rate after the operation. Management of fistula in ano includes control of sepsis, closure of fistulous tract, maintenance of continence and preventing recurrence. Surgical techniques like fistulotomy, fistulectomy, primary closure after excision of tract, seton use and staged operations have rendered the postoperative period uneventful, short and steep fall in recurrence rate. Complications of fistula surgery are myriad, like fecal soiling, mucus discharge, varying degrees of incontinence and recurrent abscess and fistula. Clearly the surgeon who has the first opportunity to treat the patient is the one most likely to effect a cure, to minimize disability and to limit morbidity. in this dissertation, an attempt is made to study the presenting symptoms, the findings on clinical examination and the various surgical procedures.

Primary Research Question: To study the clinical presentations and evaluation of different operative techniques for fistula-in-ano.

Primary Hypothesis: No hypothesis could be formulated since it is an observational study.

Primary Objectives:

1. To study age and sex distribution of fistula-in-ano.
2. To study clinical presentation of fistula-in-ano.
3. To study predisposing factors if any for the development of fistula-in-ano.
4. To study co-morbid factors associated with fistula-in-ano.
5. To study different modalities of surgical approach and efficacy with special reference to sphincter incontinence in the immediate post-op period.

METHODS

1. Study design: Observational study.
2. Study setting: Tertiary health care center.
3. Study population: Patients.

4.Duration of study: 18 months, January 2019 to July 2020

1. Sample size: 50
2. Sampling technique: Non-random, Purposive.
3. Method of selection of study subjects: After having obtained permission from Institutional Ethics Committee and Institutional Scientific Review Committee approval, patients with fistula-in-ano will be included in the study as per the following criteria:
4. a) Inclusion criteria: The patients who are clinically diagnosed as fistula-in-ano and admitted to the hospital, will be included in this study.
5. b) Exclusion criteria: -All fistulas and sinuses occurring elsewhere in the body are excluded. -All congenital fistulas are excluded. -All fistulas due to perineal injuries are excluded.
6. c) Subject withdrawal criteria: unwillingness on part of the patient is the only withdrawal criteria.

Results: Included with the study in tabulated and graphical manner.

CONCLUSION:

1. Fistula in ano is commonly seen in the age group of 30-60 yrs.
2. Gender-wise higher incidence of anal fistula is seen in males.
3. Most common clinical presentation is perianal discharge followed by perianal pain, swelling, constipation, per rectal bleed.
4. There are no specific predisposing factors associated. Chronic constipation and a past history of perianal abscess may be found in these patients.
5. The most common co-morbidity found in these patients is diabetes.
6. Fistulotomy and fistulectomy are the two most commonly performed procedures. The efficacy of both these procedures in terms of immediate postoperative measure in terms of incontinence is very good, and the patients remained continent postoperatively.