Comparison of Postoperative Wound Healing in Fistulectomy and Fistulectomy With Marsupialization in Patients With Low Fistula-in-Ano

Fistula-in-ano is a relatively common benign disease of the anorectal region, which may pose considerable complications in terms of surgery, as this disease has the propensity to recur and may be accompanied by postoperative wound healing. Surgical therapy can be considered the key in the management, and surgery involves fistulectomy or fistulotomy as a part of surgical treatment. Nevertheless, due to the fear of slow healing of the wound and acquiring infection because of common methods, some other methods have been explored, and some have been suggested to be defined as the process of marsupialization, which could allow decreasing the size of the open wound and stimulate its recovery quicker. To compare the incidence of postoperative wound infection between fistulectomy alone and fistulotomy with marsupialization in patients with low anal fistula. The study(randomized controlled trial) was done in Arif Memorial Teaching Hospital and Central Park Medical College, Lahore, from January to September 2024. Low fistula-in-ano patients were randomized into two groups, i.e., Group A (SUR one fistulectomy) and Group B (170 patients in each group). The same surgical team applied all their procedures to reach spinal anesthesia. Wound infection was determined after the operation was done clinically and verified by culture at 10 days of follow-up. Statistical analyses based on SPSS version 26 were carried out, and p < 0.05 was considered significant. Average age of sample population was 36.3, 12.2 years, with males prevailing (80.9 %). Baseline data were similar between the two groups. All in all, there were 58 patients (17.1%) who had wound infections after the operation. Group B (fistulotomy with marsupialization) resulted in a much lower wound infection rate (10.0%) as compared with group A (24.1%) (p=0.001). The findings presented in subgroup analyses indicated that the benefit of marsupialization was consistent across all age, gender, fistula type, and duration of the disease, with the majority of the differences being statistically significant. Fistulotomy and marsupialization showed a considerably reduced postoperative wound infection rate compared to the conventional fistulectomy in patients with low fistula-in-ano.