Manoj Andley, MS, Abhishek Anand, MS, Ashok Kumar, MS, Gyan Saurabh, MS, Sudipta Saha, MS, Ajay Kumar, MS, MCh, Rahul Pusuluri, MS, Nikhil Talwar, MS. LADY HARDINGE MEDICAL COLLEGE , NEW DELHI
INTRODUCTION: This study was conducted to compare the surgical outcome of Video Assisted Anal Fistula treatment (VAAFT) with conventional fistulotomy in low fistula-in-ano patient.
METHODS AND PROCEDUREL: We conducted Prospective randomized controlled study wherein 60 patients were randomized with www.randomizer.org by block randomization. They were allocated to undergo either Fistulotomy(n=30) or VAAFT(n=30).Patients were assessed clinically by digital rectal examination, proctoscopy and fistulogram.All patients underwent anal manometry to assess resting anal pressure a day before the surgery and one month after surgery.Operative time, blood loss, post-operative visual analogue scale (VAS) for pain, time taken to resume work after surgery ,patient acceptability and satisfaction ,post-operative complication – recurrence, surgical site infection and incontinence within 3 month and day of discharge were observed in both groups . Levene’s test, Chi square test, Student t test and Mann Whitney U test were used for statistical analysis.
RESULTS : The mean age was 36.43 years in VAAFT and 32.80 years in fistulotomy.In VAAFT, there were 96.7% male and 3.3% female patients, while in the Fistulotomy,86.7% male and 13.3% female.Mean operative time in VAAFT & Fistulotomy was 47.63 minutes and 34.50 minutes respectively with significant difference (P=.0001). The difference in number of blood soaked gauze pieces was significantly (P=.0001) more in fistulotomy .The mean VAS score for VAAFT was 0.43, 0.37 and 0.40 at 6, 12 and 24 hours ,whereas in fistulotomy,mean VAS score was 1.73, 2.80 and 2.53 at 6, 12 and 24 hours with significant difference(p=0.0001).Mean time taken to resume work in case of VAAFT and Fistulotomy was 2.27 days and 3.27 days respectively with significant difference(p=0.032). The difference in responses on Likert scale between the two procedures for pain evaluation and level of satisfaction post-surgery was significantly (p=0.0001)better in VAAFT. In VAAFT recurrence rate was 3.3%, surgical site infection rate was 0% and incontinence rate was 0%, While in fistulotomy, recurrence rate was 10%,surgical site infection rate 3.3% and incontinence rate was 0%. This difference is insignificant (p=0.339).There was insignificant difference in pressure changes observed in between pre-operative and post-operative basal pressure in case of VAAFT (p=0.901) and fistulotomy (p=0.712).The difference in pre and post-operative squeeze rectal pressure was insignificant IN VAAFT (p=0.894) and fistulotomy (p=0.179).Mean day of discharge in case of VAAFT and Fistulotomy was 1.30 days and 2.73 days with significant difference(p=0.0001).
CONCLUSION : VAAFT has a better surgical outcome as compared to conventional fistulotomy in low fistula in ano patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79836
Program Number: S133
Presentation Session: Colorectal 2
Presentation Type: Podium