CLINICOPATHOLOGICAL PROFILE AND SURGICAL OUTCOME OF PERIANAL FISTULA IN KASHMIR VALLEY.

Abstract

Background: Perianal fistula is a benign disease of anorectum with significant clinical diversity and management difficulties.

STUDY DESIGN: Prospective observational study.

PARTICIPANTS: 124 patients diagnosed with perianal fistula from August 2017 to June 2019 and operated at SKIMS Soura.

OBJECTIVES: The objectives of this study included to study the demographic profile, the course of fistulous tract, histopathology and surgical outcome of various techniques.

MATERIAL AND METHODS: A total of 124 patients diagnosed with perianal fistula were included in the study. All of them underwent MR fistulogram. All fistulous tracts were sent for histopathological examination. Patients were followed for 12 months postoperatively.

RESULTS: In our study, 92.8% patients were ≤ 60 years of age with high male preponderance (89.5%) , 62.9% patients belonged to rural areas and 37.1% patients belonged to urban areas. Perineal discharge was the commonest complaint (95.96%) followed by perianal swelling (44.3%) , perianal pain (41.12%) , fever (18.54%) perineal itching (8.06%) and bleeding PR (5.64%) . Intersphincteric (47.58%) followed by transphincteric fistulas (45.16%) accounted for the major types of fistula, suprasphincteric (4%) and extrasphincteric (3.22%) fistulas represented a relatively rare finding.96.8% patients had chronic nonspecific granulation tissue on histopathology, 1.6% had tuberculosis, 0.8% Crohn’s disease and 0.8% had mucinous adenocarcinoma. Finally, 11.29% patients developed recurrence and 9.67% patients had incontinence.

CONCLUSION: Perianal fistula is predominantly a disease of men in the age range of 26 to 60 years. Preoperative MR fistulogram in complex fistula in ano helps tailor the management plan which has a significant impact on the final outcome. It is prudent to send all biopsy specimens for HPE and initiate the appropriate treatment accordingly.