MARSUPIALIZATION OF FISTULOTOMY WOUNDS IMPROVES HEALING - A RANDOMIZED CONTROLLED TRIAL

Background Marsupialization of anal fistulotomy wounds leaves less raw unepithelialized tissue to granulate and may improve wound healing. M ethods Some 103 consecutive patients with uncomplicated intersphincter ic or trans-sphincteric fistula in ano were recruited into a randomize d 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 fistul a tract with interrupted absorbable sutures (MS group). Anal manometry was performed before operation, and 6 weeks and 3 months after surger y. Results 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 tim es 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 gr oup was incontinent of liquids after operation compared with six (12 p er cent) in the LO group. There was less impairment in maximum anal sq ueeze pressure at 3 months after marsupialization compared with leavin g fistulotomy wounds open (P < 0.05). Apart from a slightly longer ope rative time required for marsupialization, the hospitalization and com plication rates were the same. Conclusion Anal fistulotomy wounds heal ed faster after marsupialization. Anal squeeze pressures were better p reserved and this may improve anal continence.