A comparative study between fistulotomy and fistulectomy in management of low anal fistulae

Ganesan R., Karunakaran K., Heber Anandan


Background: Fistula in ano is a silent menace in human beings, the treatment is a challenging one even for experienced surgeons, fistula in ano forms a good majority of treatable benign lesions of rectum and anal canal. Aim was to study the efficacy of fistulotomy and fistulectomy in the treatment of low anal fistulae.

Methods: A randomized control study was conducted to compare fistulotomy with fistulectomy in patients with low anal fistulae.

Results: The operating time in fistulotomy group was 12.13minutes±2.11minutes and in fistulectomy group was 22.23±3.36minutes. The post-surgery hospital stays in Group I was 1.80±0.66days and in Group II was 2.60±0.563 days. The wound healing time in Group I was 24.20±2.95 days which was considerably less when compared to patients in Group II where it was 31.50±4.34 days.

Conclusions: Fistulotomy has a slight edge over fistulectomy in the treatment of low anal fistulas since it has shorter operating time, less post-operative pain, less complications, quicker wound healing time, less incontinence and a comparable recurrence rate.


Fistula-in-Ano, Low anal fistulae

Full Text:



Sainio P. Fistula-in-ano in a defined population: incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73(4):219-24.

Sharma D. Advances in the management of fistula in ano. World Journal of Pharmaceutical Research. 2017;1218-24.

Janugade BH, Hoshedar Tata N, Mohammad Ashar S, Janugade HD, Kamboj P. A clinico-pathological study of fistula-in-ano. Journal Evolution Medical Dental Sciences. 2016;5(86):6395-8.

Parks AG. The pathogenesis and treatment of fistula in ano. Brit Med J. 1961;1:463-9.

Kronborg O. To lay open or excise a fistula-in-ano: a randomized trial. Br J Surg. 1985;72(12):970.

Jacob TJ, Perakath B, Keighley MRB. Surgical intervention for anorectal fistula. Cochrane Database Syst Rev. 2010;(5):CD006319.

Malik AI, Nelson RL. Surgical management of anal fistulae: a systematic review. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2008;10(5):420-30.

Belmonte Montes C, Ruiz Galindo GH, Montes Villalobos JL, Decanini Terán C. Fistulotomy vs fistulectomy. Ultrasonographic evaluation of lesion of the anal sphincter function. Rev Gastroenterol Mex. 1999;64(4):167-70.

Shouler PJ, Grimley RP, Keighley MR, Alexander-Williams J. Fistula-in-ano is usually simple to manage surgically. Int J Colorectal Dis. 1986;1(2):113-5.

Cavanaugh M, Hyman N, Osler T. Fecal incontinence severity index after fistulotomy: a predictor of quality of life. Dis Colon Rectum. 2002;45(3):349-53.

Khubchandani M. Comparison of results of treatment of fistula-in-ano. J R Soc Med. 1984;77(5):369-71.

Vasilevsky CA, Gordon PH. Results of treatment of fistula-in-ano. Dis Colon Rectum. 1985;28(4):225-31.