Marsupialization for simple fistula in ano: a randomized controlled trial

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Anal Fistula Treatment

Background:

• Anal fistulotomy can result in significant wound surface area.
• Marsupialization aims to reduce this raw surface, potentially improving recovery.
• The efficacy of marsupialization for simple anal fistulas requires further investigation.

Purpose of the Study:

• To evaluate the benefits of marsupialization in conjunction with fistulotomy for simple anal fistulas.
• To compare postoperative pain, analgesic requirements, and complications between fistulotomy alone and fistulotomy with marsupialization.

Main Methods:

• A randomized controlled trial involving 50 patients with simple fistula in ano.
• Patients were assigned to either fistulotomy or fistulotomy with marsupialization.
• Outcomes assessed included pain scores, analgesic use, complications, recurrence, and incontinence.

Main Results:

• No significant difference in immediate postoperative pain or pain after the first defecation.
• Fewer patients in the marsupialization group required pethidine (4 vs 13, p=0.017).
• Complications were marginally higher in the fistulotomy-only group (p=0.0501); no recurrences or incontinence observed.

Conclusions:

• Marsupialization is a safe adjunct to anal fistulotomy for simple fistulas.
• This technique appears to improve postoperative outcomes by reducing the need for potent analgesics.