Background: Fistula in ano is one of the commonest benign anorectal condition encountered during the day today practice. There are different treatment modalities available for the management of anal fistula. These include fistulotomy, fistulectomy, LIFT, seton placement, advancement flaps and use of biological agents like fibrin glue. In this prospective randomized clinical study, we have studied the outcomes after fistulotomy and fistulectomy in patients with simple low-lying fistula.Methods: Total 84 patients with simple low-lying fistula were randomized into two groups of fistulotomy and fistulectomy (42 patients each). The intraoperative and postoperative findings noted, and the results are compared. The results are analyzed using statistical tests like student’s t test and chi square test.Results: The mean duration of surgery in fistulotomy group was 28.6min and that of fistulectomy group was 31.7 min. The difference in duration of surgery is statistically not significant (p>0.05). The median duration of wound healing was shorter in the fistulotomy group (12 days) compared to the fistulectomy group (21 days) and the difference is statistically highly significant (p<0.001). The incidence of incontinence in fistulotomy group observed in 5 cases compared to single case in fistulectomy group. This difference is again statistically significant. Recurrence observed in one case from both the groups each within 6 months post-op period.Conclusions: The results of fistulotomy and fistulectomy are comparable with respect to duration of surgery, postoperative pain and recurrence rate. The postoperative wound healing is faster in fistulotomy; while incontinence is also higher in fistulotomy group.

BACKGROUND:This study was carried out to evaluate possible differences of pre and post treatment parameters between patients undergoing injection Sclerotherapy, rubber band ligation and hemorrhoidectomy. METHODS: The prospective study was carried out in 150 patients of haemorrhoids during August 2010 to November 2012. Each group of 50 patients treated with injection sclerotherapy, band ligation and haemorrhoidectomy and followed up for 1 year for complications. RESULTS: In the present study pain, bleeding and urinary retention were common following haemorrhoidectomy. One patient had anal incontinence post sclerotherapy. Anal incontinence was found to be a major problem in post haemorrhoidectomy period. Two patients had anal stenosis after haemorrhoidectomy. Second setting required in 6 patients of sclerotherapy and 4 patients of rubber band ligation. No recurrence noted in haemorrhoidectomy patients. Following sclerotherapy, 35 (70%) patients resolved, 9 (18%) improved and 3 (6%) remained unchanged. Following rubber band ligation, 32 (64%) resolved, 12 (24%) improved and 3 (6%) unchanged, while after haemorrhoidectomy, 37 (74%) resolved and 10 (20%) improved. DISCUSSION: Injection sclerotherapy remains the choice in first degree haemorrhoids. Rubber band ligation can be considered as first line of treatment for second degree haemorrhoids and few cases of third degree haemorrhoid. Conservative methods are acceptable to patients in outcome and in patient compliance, but repetitions of treatment may be needed. Haemorrhoidectomy remains the only form of therapy with lasting results. Thus it should be considered for all cases of third and fourth degree haemorrhoids and for uncontrollable symptomatic recurrences following conservative procedures.

Traumatic displacement of the testis is a rare occurrence and is defined as the displacement of one or both testis to a position other than the scrotum (1) .Traumatic displacement of testis is commonly a delayed diagnosis during treatment occurs as a consequence of high velocity road traffic accident (2) usually following a motorcycle collision, in what is referred to as "fuel tank injury". Early identification and subsequent surgical management is of utmost importance to maintain normal spermatogenesis in the displaced testis. We report a case of traumatic displacement of testis in superficial inguinal pouch in a young man presented 1 year after a road traffic accident. The clinical diagnosis was well supported by USG. The patient was successfully treated by inguinal exploration and repositioning of testis in scrotum, under spinal anesthesia.