Background: Fistula-in-ano (FIA) is a common perianal condition associated with significant morbidity and remains a surgical challenge due to varied anatomy and risk of recurrence. Accurate pre-operative assessment and appropriate surgical selection are essential for optimal outcomes. Objectives: To evaluate the clinical profile, predisposing factors, anatomical characteristics and surgical management of patients with FIA. Materials and Methods: This hospital-based observational study included 60 adult patients with FIA managed between June 2023 and January 2025. Clinical presentation, previous history of perianal abscess, comorbidities, fistula characteristics and magnetic resonance imaging (MRI) fistulogram grading were recorded. Surgical management included fistulotomy, fistulectomy, seton placement and ligation of the intersphincteric fistula tract. Patients were followed up for 1–3 months to assess post-operative outcomes and complications. Results: The majority of patients were aged 31–60 years (55%), with a slight male predominance (53.3%). Pain (76.7%) and discharge (55%) were the most common presenting symptoms. A prior history of perianal abscess was noted in 66.7% of patients. Intersphincteric fistulae (65%) and low-level fistulae (85%) predominated. Grade 1 disease was the most common MRI finding (45%). Fistulectomy was the most frequently performed procedure (70%). Most patients (81.7%) had no post-operative complications, with low rates of recurrence (5%) and no incidence of incontinence. Conclusion: FIA predominantly affects middle-aged adults and is commonly associated with a previous history of perianal abscess. MRI fistulography aids in accurate classification and surgical planning. Appropriate surgical management resulted in favorable short-term outcomes with minimal complications. Larger multicentre studies with longer follow-up are required to assess long-term outcomes and recurrence.
Priya et al. (Thu,) studied this question.