Fistulotomy versus Fistulectomy as a Treatment for Low Anal Fistula in Infants: A Comparative Study

Abstract

Objective: To compare between two methods of surgical treatment for fistula-in-ano (FIA) in infants, fistulotomy and fistulectomy, and their surgical outcome and also to review the clinical presentation and diagnosis of this condition in our tertiary center.

Background: FIA occurring in infants is a relatively common condition. It is more common in boys than in girls, and 96% of cases occur in infants younger than 1 year. The surgical treatment options of these fistulas are fistulotomy or fistulectomy.

Patients and methods: In this study, between January 2010 and December 2011, 36 infants with low-type FIA were treated surgically. Eighteen infants were treated by fistulotomy (group A) and 18 were treated by fistulectomy (group B). No infant had underlying illness. All cases were subjected to the same protocol of preoperative evaluation, anesthesia, and follow-up protocol. The two techniques were compared in terms of the operative time, healing time, complications, and outcome. All were reported, analyzed, and compared.

Results: Male sex predominance was reported. Twentyseven infants were younger than 1 year old and the remaining patients were in their second year of life, with a mean age of 9.7± 4.9 months. The mean values of healing time were 21± 3.01 days for group A (range 17–28 days) and 26.6 ± 1.42 days for group B (range 25–30 days). There was a statistically significant difference between the two groups in both the operative time and the healing time. There was one recurrence and one granuloma in group B. One wound infection was reported in patients who underwent fistulotomy (group A).

Conclusion: The treatment of FIA in infants remains controversial and it can be treated either by fistulotomy or by fistulectomy. However, there are fewer risks and shorter recovery times associated with fistulotomy as compared with fistulectomy. A future study involving nonoperative management would be required to assess other treatment options.

Keywords: Fistula-in-ano, Fistulectomy, Fistulotomy