Marsupialization of fistulotomy wounds improves healing: a randomized controlled trial

Marsupialization of anal fistulotomy wounds leaves less raw unepithelialized tissue to granulate and may improve wound healing.

Some 103 consecutive patients with uncomplicated intersphincteric or trans-sphincteric fistula in ano were recruited into a randomized controlled trial. Fistula tracts were identified and laid open under general anaesthesia. The patients were randomized to have either the wounds left open (LO group) or wound edges marsupialized to the fistula tract with interrupted absorbable sutures (MS group). Anal manometry was performed before operation, and 6 weeks and 3 months after surgery.

Some 52 patients were randomized to the LO group and 51 to the MS group. There were no differences in the age, sex, fistula type and fistula length distribution between the groups. Mean follow-up times were 9 and 10.2 months respectively. Wounds in the MS group healed faster (mean(s.e.m.) 6.0 (0.4) weeks) than those in the LO group (10.0(0.5) weeks) (P < 0.001). Only one patient (2 per cent) in the MS group was incontinent of liquids after operation compared with six (12 per cent) in the LO group. There was less impairment in maximum anal squeeze pressure at 3 months after marsupialization compared with leaving fistulotomy wounds open (P < 0.05). Apart from a slightly longer operative time required for marsupialization, the hospitalization and complication rates were the same.

Anal fistulotomy wounds healed faster after marsupialization. Anal squeeze pressures were better preserved and this may improve anal continence.