To lay open or excise a fistula-in-ano: a randomized trial

Area of Science:

• Colorectal surgery
• Surgical outcomes
• Anal fistula treatment

Background:

• Fistula-in-ano is a common anorectal condition.
• Surgical intervention is the primary treatment modality.
• Optimal surgical technique remains debated.

Purpose of the Study:

• To compare the efficacy of two surgical treatments for fistula-in-ano: lay open versus excision.
• To evaluate healing times, need for revisional surgery, and recurrence rates.

Main Methods:

• A randomized controlled trial was conducted.
• Patients with fistula-in-ano were randomized to either lay open or excision.
• Outcomes measured included time to healing, revisional surgery, and recurrence within one year.

Main Results:

• The lay open technique demonstrated significantly shorter healing times (median 34 days) compared to excision (median 41 days) (P < 0.02).
• Revisional surgery was required in 3/26 patients (lay open) and 2/21 patients (excision).
• One-year recurrence rates were comparable between the two groups (3/24 lay open vs. 2/21 excision).

Conclusions:

• Laying open the fistula is a more effective surgical treatment for fistula-in-ano regarding healing time.
• Both lay open and excision techniques show similar recurrence rates.
• The lay open method is recommended for improved patient recovery in fistula-in-ano management.