Clinical Study of Various Modalities of the Treatment of Fistula in Ano in Maharashtra Population

  • Zulfikar Jigarali Rupani
  • Nitin Appasaheb Raje
  • Michelle Nitin Raje
Keywords: Fistulectomy, Fistulogram, Fistulotomy, Sparing, Sphincter


Background: Fistula in ano is one disease which is easy to diagnose but difficult to cure as patients report very late phase of
the disease and it leads to problems, because it has different locations, openings, and positions.
Materials and Methods: A total of 180 adult patients having fistula in ano were studied. PR examination, photoscopy, and
fistulogram were done for planned surgical treatment. All pre-operative routine blood examination was carried out. Surgery was
done under appropriate anesthesia and dissected part was sent for histopathological examination. Based on histopathological
report, patients were treated postoperatively in fistulectomy surgeries, treated with broad-spectrum antibiotics post-surgically.
Results: Clinical manifestations were 168 (93.3%) had peroneal discharge, 135 (75%) had history of peroneal abscess, 53 (29.4%)
had pain, 173 (96.1%) had swelling, 153 (85%) had only one opening, 27 (15%) had more than 1 opening, 28 (15.5%) had
interiorly located, and 152 (84.4%) had posteriorly located. One hundred and fifty-six (86.6%) were positioned low and 24 (13.3%)
had high position. Types of surgeries were 126 (70%) had fistulotomy, 20 (11.1%) fistulotomy, and 34 (18.8%) had seton thread.
Post-operative results were 172 (95.5%) had complete healing and 8 (4.4%) had recurrence of fistula.
Conclusion: Fistulotomy technique is associated with slightly high rate of recurrence but low chances of anal incontinence. It
has shorter operating time with less post-operative pain and less time is needed for wound healing as compared to fistulectomy.

Author Biographies

Zulfikar Jigarali Rupani

Assistant Professor, Department of General surgery, Vedanta Institute of Medical Sciences, Palghar, Maharashtra, India

Nitin Appasaheb Raje

Assistant Professor, Department of Radiology, Vedanta Institute of Medical Sciences, Palghar, Maharashtra, India

Michelle Nitin Raje

Assistant Professor, Department of Radiology, Vedanta Institute of Medical Sciences, Palghar, Maharashtra, India


1. Malik A, Nelson R. Surgical management of and Fistula a
systemic review. Colorectal Dis. 2008;10:420-30.
2. Murtuza A. Fistula in Ano an over view. J Int Med Sci Acad
3. El-Tiwari AM. Current management of crypto glandular
fistula in ano, an introduction world. J Gastroentrol
4. Mishra S. Bhava Mishra, Bhava Prakash Nighantu. 1st ed.,
Vol. 1. Uttar Pradesh: Chowkhamba Sanskrit Series Office
Varanasi India; 1969. p. 114-6, 307-9.
5. Jethva J, Patel A, Gadhavi J. Study of mangement of 25 cases
of fistula in ano. Int Area Integrat Med 2015;25:37-42.
6. Kamal ZB. Fistulotomy versus fistulectomy as primary
treatment of low and fistula in ano. Iraqi post-grad. Med J
7. Gupta SK, Vegad KK. Comparative study of management
of fistula in ano with partial fistulectomy combined with
medicated Seton technique and conventional fistulectomy.
Ind J Appl Res 2015;5:679-83.
8. Lummis PJ, Philips RK. Anal Fistula Evaluation and
Management Specialist Surgical Practice Colorectal Surgery.
5th ed., Vol. 14th. London, UK: Hospital and Academic
Institute of London, UK, Elsevier; 2014. p. 215-7.
9. Shaikh IA, Shukr I, Hanifi MS. Fistulotomy v/s fistula in
the treatment of simple low anal fistula. Of male patients
pal Armed forces. Med J 2015;656:798-802.
10. Kirk RM. General Surgical Operations. 4th ed. Hoff Brand
Edinburg. London, United Kingdom: Churchill Livingstone;
2000. p. 361-3.
11. Degue CK, Desoza SM. Faecal in continence as consequences
of an rectal surgeries and physio therapeutic approach.
J Coloproctol 2011;31:248-56.
12. Berg OK. To lay open or incise a fistula in ano randomized
trial. Br J Surg 1985;72:970-3.