Comparative Study of Conventional versus Marsupilized Fistulotomy of Recurrent Perianal Fistula

Abstract

Introduction and Aim: There is a paucity of studies comparing marsupialization with the conventional fistulotomy technique in the management of recurrent perianal fistula. The current study aimed to compare between conventional and Marsupilized fistulotomy procedures in the management of recurrent perianal fistula regarding perioperative outcomes (pain, infection, healing time, incontinence, and recurrence).

Methodology: Twenty four patients with recurrent perianal fistula and underwent conventional surgery (Group A) or fistulotomy with marsupialization, were included. The preoperative assessment achieved by history taking, physical examination and laboratory investigations. The patients were discharged on the first postoperative day. The severity of postoperative pain was assessed by the visual analogue scale. Patients were informed about regular outpatient visits after one week, two weeks, one month, three months, six months and nine months to assess wound healing, recurrence, inflammation and incontinence. Both groups were compared for postoperative pain, infection, rate of healing, time for healing, recurrent and postoperative incontinence.

Results: Both groups were comparable regarding patient age, sex distribution (most included cases were males), preexisting medical comorbidities. Perianal discharge was present in all cases. Anal pain was reported by 33.33 and 25% of cases in the conventional and Marsupilized groups respectively. There was a significant increase in operative time in the Marsupilized than the conventional group (38.75 vs. 27.08 respectively, p < 0.001). The duration of wound discharge showed a significant reduction in the Marsupilized than conventional (2 weeks versus 3 weeks). Wound size was 2.11 and 3.31 cm³ in the Marsupilized and conventional groups respectively (p = 0.033). Time needed for wound healing showed a significant shortening in the Marsupilized group (p = 0.005).

Conclusion: Marsupialization during surgical management of perianal fistula is associated with better post-operative outcome regarding wound size, discharge, and time for complete healing.