Abstract: Aims
1.To find the age and sex incidence of fistula in ano
2.To study the various modes of clinical presentation of fistula in ano
3.To evaluate short term and long-term recovery with post-operative pain, persistence of fistula, anal incontinence and bleeding
4.To study the efficacy of laser fistulectomy
Materials and Methodology: This is a prospective observational study in Shri Chhatrapati Shivaji Maharaj Sarvopchar Rugnalay, Solapur. Total 30 patients who will be treated for fistula in ano at our tertiary hospital will be analyzed in this study. Patient will undergo routine hematological and radiological investigations. Patients will be operated for laser fistulectomy. Post-operative complications like pain, discharge, fecal incontinence, length of hospital stay, recurrence will be analyzed. Patients will be followed for a period of three months.
Results
1.Age distribution: Majority of the patients belonged to the age group of 30-39 years (30%). Mean age was 40.8 with standard deviation of 13.01.
2.Gender distribution: 80% patients were males as opposed to 60%.
3.Type of fistula: Patients had extra-sphincteric fistula whereas 23% had inter-sphincteric fistula; 13% had trans-sphincteric fistula o 20% females concluding that fistula in ano is more common in males.
4.Co-morbidities: Hypertension was the most common co-morbidity encountered, followed by Diabetes, Coronary artery disease.
5.Clinical presentation: Most common presenting complaints were discharge (38%) followed by pain (34%) and itching (14%) followed by swelling (7%).
6.History of previous surgery: 10% patients had a history of surgery for perianal abscess, were associated tran-sphincteric type of fistula in ano. 6% patients underwent fistulotomy for extra-sphincteric fistula.
7.Hospital stay: 56% patients were discharged on Day 2 post-operatively, followed by 30% patients on day 4 and 5 and 13% on more than day 5.
8.Post-operative complications: Post-operatively 63% patients experienced pain, followed by 26.6% of the patients who discharge and 13.3% had had recurrence in a period of 3 months.
Conclusion: Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practice. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcomes, which is quite inevitable following conventional surgical treatment.
For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of trying to minimize the injury to the anal sphincters and preserving optimal function FiLaC uses a laser probe which is easier to insert independently as well as in patients with an indwelling seton, assisting in the maturation of the primary tract by inducing fibrotic reshaping of the fistula lumen. FiLaC is essentially a "blind" procedure hence it has the potential of missing secondary tracts which may lead to recurrences. Long-term randomized control trials are necessary to determine the success rate of this procedure.
