A COMPARATIVE STUDY BETWEEN FISTULA TRACT BRUSHING/FLOSSING AND FISTULOTOMY IN TERMS OF POSTOPERATIVE PAIN AND WOUND HEALING IN PATIENTS WITH FISTULA-IN-ANO

Abstract

Background: Fistula-in-ano is a common anorectal disorder in which conventional fistulotomy, though effective, is associated with significant postoperative pain, wound morbidity, and delayed healing. Fistula tract brushing/flossing is a sphincter-preserving, minimally invasive alternative that mechanically debrides the tract without laying it open. Objective : To compare fistula tract brushing/flossing with conventional fistulotomy with respect to postoperative pain, wound healing, and complication profile in patients with low anal fistula. Methods: This prospective comparative study was conducted over 18 months in the Department of General Surgery, Saveetha Medical College and Hospital. Forty patients with low anal fistula were allocated to Group A (fistula brushing/flossing, n=20) or Group B (conventional fistulotomy, n=20). Postoperative pain (VAS at 24 hours, day 3, day 7, and week 4), wound healing time, return to activity, complications, recurrence, and patient satisfaction were assessed. Data were analyzed using SPSS v25.0 with independent t-test and chi-square test; p<0.05 was considered significant. Results: The mean age of participants was 41.8  ±10.4 years, with 72.5% male predominance and predominantly intersphincteric fistulas. Group A demonstrated significantly lower postoperative pain scores and earlier wound healing compared with Group B. Complication rates were low and comparable in both groups, with no continence disturbances observed. Conclusion: Fistula tract brushing/flossing is a safe, sphincter-preserving alternative to conventional fistulotomy, offering reduced postoperative pain and faster recovery, though fistulotomy retained a marginal advantage in recurrence rates. Larger multicentric randomized trials are recommended.