Management Of Fistula In Ano: An Overview

Background: Fistula-in-ano is an abnormal communication between the anal canal or rectum and the perianal skin. Most commonly caused by an anorectal abscess resulting from cryptoglandular infection. Patient usually presents with intermittent or constant purulent perianal discharge. There is usually a history of anorectal abscess that ruptured spontaneously or was surgically drained. Digital rectal examination remains the main stay of diagnosis in anorectal fistula cases. Methods: Data of 69 patients who were admitted at SMVD Superspeciality Hospital Katra from 1st May 2016 to 30th April 2018 was analyzed retrospectively. In addition to clinical examination, routine investigations and Digital Rectal Examination, MRI fistulography was done in all cases and appropriate surgical management was done. Data was analyzed retrospectively for intraoperative findings, nature of surgery, intra and postoperative complications and recurrence. Results: Most common mode of presentation in our study was perianal discharge and discomfort (98%). 66 (95.6%) patients were males with a male to female ratio of 13.2:1. Young adults (40-50 years) were most commonly involved comprising 28 patients (40.5%). 55 Patients (79.7%) had single opening. 27 patients (40%) had previous history of surgical drainage of perianal abscess. 55 Patients (80%) had posterior opening while 14 patients (20%) had anterior opening. Fistulectomy and fistulotomy were performed in 55 patients (80%) and 4 patients (20 %) respectively. Conclusion: Anal fistula is a common disease which results from cryptoglandular infection. The complexity of the disease poses challenges to the surgeon. Early diagnosis and appropriate management are the key to success.