Marsupialization for Simple Fistula in Ano: A Randomized Controlled Trial
Chucheep Sahakitrungruang MD, MSc*, Jirawat Pattana-arun MD*, Supakij Khomvilai MD*, Kasaya Tantiphlachiva MD*, Puttarat Atittharnsakul MD*, Arun Rojanasakul MD*
Affiliation : * Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Marsupialization of anal fistulotomy results in less raw-surface wound and may improve postoperative
outcomes. The present study was designed to test the benefit of marsupialization for simple fistula in ano.
Material and Method: This was a randomized controlled study conducted at King Chulalongkorn Memorial Hospital,
Bangkok, Thailand. Fifty patients with simple uncomplicated fistula in ano were allocated into either fistulotomy group or
fistulotomy with marsupialization group. Patients with complex fistula in ano, prior incontinence, immuno-compromised
status and bleeding tendency were excluded from the present study. The postoperative pain score, the pain score after the first
defecation, total amount of the analgesic usage and complications were evaluated. Recurrence was also assessed.
Results : There was no difference in the postoperative pain score between the treatment groups. However, there was a
significant difference (p = 0.017) in the number of patients who needed pethidine injection (4 patients of the fistulotomy with
marsupialization group versus 13 patients of the fistulotomy group). There was no statistical significant difference in the pain
score after the first defecation and the amount of paracetamol usage in seven days. Five complications were found only in the
fistulotomy group but the significant level was marginal (p = 0.0501). There was no recurrence of the fistula and none of the
patients developed anal incontinence after the surgery.
Conclusion : Marsupialization for anal fistulotomy is safe. This technique helps to improve the postoperative outcomes.
Keywords : Fistula in ano, Fistulotomy, Marsupialization, Postoperative pain, Outcome
