A PROSPECTIVE COMPARISON OF OPEN FISTULECTOMY VS. STANDARD FISTULOTOMY FOR LOW-LYING CRYPTOGLANDULAR ANAL FISTULAE: A MULTICENTER RANDOMIZED CLINICAL TRIAL
Abstract
Background: Fistula-in-ano, arises from cryptoglandular infection, necessitates surgical management meant for eliminating the pathological tract while strictly preserving anal sphincter function. For low-lying fistulae (Garg Grade I-II), both fistulotomy (laying open the tract) and fistulectomy (complete excision) are utilized, yet consensus remains elusive regarding optimal recovery dynamics, particularly concerning postoperative pain and wound healing time. This trial aimed to definitively compare these two standard procedures in a standardized patient cohort.
Materials and Methods: This study enrolled 120 patients presenting with simple, low-lying intersphincteric or low transsphincteric anal fistulae in a prospective, randomized, single-blinded trial (1:1 allocation: $n=60$ fistulotomy, $n=60$ fistulectomy). Patients with systemic disease or complex fistulae were excluded. Primary endpoints were mean wound healing time (days) and acute postoperative pain (Visual Analog Scale, VAS). Secondary endpoints included operative time, length of hospital stay (LOS), and 12-month complication rates (recurrence and incontinence using the Wexner score).
Results: This trial concludes that for low-lying anal fistulae, **fistulotomy is the preferred standard of care**, demonstrating significant superiority over fistulectomy. Fistulotomy offered greater efficiency with dramatically shorter operative times and hospital stays, alongside accelerated patient recovery. It resulted in significantly lower acute pain and accelerated wound healing by over one week ($27.5$ days vs $39.1$ days, $p<0.001$). Both procedures were equally effective long-term, showing equivalent, low rates of recurrence and sphincter incontinence. (74 words).
Conclusion: For low-variety anal fistulae, standard fistulotomy offers statistically and clinically superior outcomes in terms of operative efficiency, reduction of acute pain, and acceleration of wound epithelialization, without increasing the risk of recurrence or functional impairment compared to fistulectomy. Fistulotomy is validated for the preferred standard of care, optimizing resource utilization and minimizing patient morbidity.
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