Fistula in Ano – Division of Internal Sphincter as a Second Stage Surgery after Putting Medicated Seton/ Single Stage Medicated Seton Only - A Prospective, Comparative Study

Fistula in Ano

Abstract

Background: We do different procedures for the treatment of fistula in Ano Fistulotomy, Fistulectomy, LIFT, VAFT, diversion and excision of tract. The idea is to prevent recurrence and incontinence of faeces and get the better results. Different types of setons are also used for intermediate and high fistula in ano. Subjects and Methods: In this study, we compared the relative safety of single stage surgery by putting medicated seton and 2 stage surgery (division of internal sphincter as a 2nd stage surgery after putting medicated seton in the 1st stage). In 15 patients, only medicated seton was put in the fistulous tract and we tried to cut the internal sphincter by tightening the medicated seton in follow up and seton was also changed at 2 weekly-interval. And in another 15 patients all the external potions of fistula were excised and medicated seton was put around the internal sphincter.3,5,8,12 When external wound healed the internal sphincter was cut under anaesthesia. Chi square test was done for qualitative difference and student t-test was done for quantitative difference. Sample size was calculated for fistula at prevalence rate of 8.6 per lakh population. The error rate was 1.4 and standard deviation was 1.3 according to the different studies available. The p value less than 0.05 was considered statistically significant. Exclusion Criteria Patient with immuno-compromised status, very high supralevator fistula. Results: Treatment of fistula in Ano by dividing the internal sphincter (after putting the medicated seton) in 2nd stage of surgery is a safe and effective method to decrease the recurrence rate in fistula in Ano. It also decreases the hospital stay and prevents the faecal incontinence compared to single stage division of internal sphincter. It also reduces the follow up visits of patients. It causes significantly less pain when compared to those patients where medicated seton is tightened to produce the cut effect on the internal sphincter. Conclusion: It can be safely said that division of internal sphincter can be done as a second stage surgery after putting the medicated seton in the first stage in complex anorectal fistulas.