A randomized controlled trial to compare postoperative pain after fistulotomy alone and fistulotomy with marsupialization for the treatment of simple fistula in ano

Abstract

Objective: To compare the following items between two techniques of simple fistula surgery, fistolotomy and fistulotomy with marsupialization: 1.Pain score in the postoperative period. 2.Pain score after the first defecation. 3.Amount of pethidine and paracetamol usage. 4.Complication. Design: Randomized controlled trial Setting: King Chulalongkorn Memorial Hospital, Bangkok, Thiland Patients: Patients with simple uncomplicated fistula in ano are eligible for this study. Patient excluded complex fistula in ano, prior incontinence, immunocompromised patient, and bleeding tendency Methods: Fifty patients who met eligible criteria were randomized allocated into 2 gropus. The patients in one group were treated by fistulotomy alone while in the other group, fistulotomy with marsupialization were done. Pre and post-operation care were same standard in both groups. The results of this study was evaluated by pain scores which were rated by the patients in the post-operation day 1,3,5,7 and 14. Patients were followed to determine pain after the first defecation, total amount of analgesic usages and their complication. Results: Pain scores in each postoperative day was statistically different (p<0.001). However, there was no difference in postoperative pain between two treatment groups. Thirteen patients fistulotomy group and 4 patients in fistulomy with marsupialization required pethidine injection that was significantly different (p=0.017), Among 2 treatment groups, there was no significant difference in first defecation pain, amount of paracetamol usage in 7 days, and complication. No one from both groups reported anal incontinence after surgery. Conclusion: Fistulotomy with marsupialization is safe and this technique provides good outcomes. Therefore it should be encouraged to be the treatment of choice for simple fistula in ano.