Early Postoperative Pain in Video Assisted Anal Fistula Treatment Versus Open Fistulectomy

Abstract

Introduction: Anal fistulas are chronic anorectal infections with constant pus containing discharge from the perianal region which can only be treated surgically.

Aims & Objectives: To compare mean duration of post-operative pain in patients undergoing video-assisted treatment (VAAFT) with patients who were cared for with an open fistulectomy.

Place and Duration of Study: This randomized controlled trial was conducted in the Surgical Department of Chaudhry Mohammad Akram Hospital, Lahore from 1st March 2022 to 31st August 2022. After necessary permission and approval from Ethics Committee and Research Department of Azra Naheed Medical College, Lahore. 60 patients who were assessed according to inclusion criteria of this study were taken.

Materials and Methods: 60 patients of both genders who had presenting complaint of anal fistula were randomly assigned to two groups ( n=30) each. Group A were provided video-assisted fistula treatment and Group B with open fistulectomy approach. Physiological parameters as age, BMI and importantly postoperative pain were observed on 2nd day post procedure. SPSS version 20 was used to analyse the data, P-value<0.05 was taken as significant.

Results: The range of age included was from 18 to 50 years with mean age of 38.6+5.8 years in group A and 40.933+5.4 years in group B (p=0.11), mean duration of anal fistula was 9.13+1.8 weeks in group A and 9.06+2.1 weeks in group B(P=0.89). Patients in group A had a mean BMI of 27.1±1.62 Kg/m² while patients in group B had a mean BMI of 27.5±1.73 Kg/m² (p=0.36). The mean duration of each procedure was 21.4+1.37 minutes in group A and 38.300+1.46 minutes in group B(p<0.001). Mean postoperative pain was 0.333±0.09 on VAS score in group having VAAFT and 2.200±0.18 in group having open fistulectomy (p<0.001).

Conclusion: In comparison with conventional fistulectomy, VAAFT seems to be superior with almost no complications post operatively and less pain.