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What Is Fistulotomy?

Reviewed by Dan Brennan, MD on April 15, 2021

A fistulotomy is a surgical procedure for treating a fistula in the anal area. An anal fistula is a small opening or tunnel that develops between the anal skin and the end of the anus. The causes of an anal fistula include injury, severe inflammation, infection, and pus collection in the area. Symptoms of the condition include:

  • Pain and discomfort that gets worse when you cough, move around, sit down, or relieve yourself
  • Difficulty in controlling your bowel movements
  • Skin irritation around the anus
  • Discharge that contains blood or pus
  • Smelly discharge near the anus
  • Swelling and redness around the anus
  • Fever caused by the pus

Through an anal fistulotomy procedure, the doctor will open and drain the fistula to help it heal. In most cases, surgery is the best treatment for the condition. This procedure is different from fistulectomy, which involves removing the fistula and the surrounding tissue of the affected organ.

What Happens During a Fistulotomy?

The surgery typically can happen in the doctor’s office as an outpatient procedure. When the fistula is large, you may need hospital admission and the surgery will happen in the operating room under general anesthesia.

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During the process, the doctor will cut on the site of the fistula. They’ll remove the entire infected area, plus the pus and other fluids. They’ll then stitch the area and leave it to heal. In some cases, they’ll leave it open and pack or cover the area with gauze.

Potential complications after the surgery include:

  • Bleeding at the site
  • Recurrence of the fistula or abscess
  • Post-surgery pain
  • Headache and drowsiness
  • Fever

What is the Purpose of a Fistulotomy?

The primary goal of a fistulotomy is to remove all the pus and fluids in the affected area or tissues. This helps them heal faster and helps close the abnormal gap. The surgery also helps reduces injury to the anal sphincter.

A fistula should never be left to heal on its own. When left untreated, fistulas can become life-threatening or lead to hard-to-treat complications like anal cancer or sepsis.

The decision to treat. Your doctor’s first consideration for the treatment of a shallow fistula will be fistulotomy. The positioning of the fistula also matters. If it’s between the internal and external anal sphincters, this surgery will be the most suitable treatment.

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For larger fistulas that are deep into the tissues, other options are available. The doctor can use an additional procedure known as sphincteroplasty to treat the sphincter after performing a fistulotomy. This process is more complex.

In other cases, a different procedure may be used that involves a seton, an elastic band or suture. The doctor will create a temporary drainage canal and then close it through surgery. In these cases, some surgeries involve laser surgery, electrocautery, or biologic glues. A doctor may recommend other treatment procedures, depending on the fistula’s condition:

  • Advancement rectal flap procedure
  • Fibrin glue or collagen plug
  • Endoscopic fistula repair
  • Fistula clip closure
  • Ligation of intersphincteric fistula tract (LIFT)

Diagnosis. To decide if fistulotomy is the best treatment, your doctor will perform a digital rectal exam. With a gloved finger, they will check the area to find out the fistula’s size and position. Some other tests may be necessary to check the actual location and pathway of the fistula:

  • X-ray with barium contrast. You will swallow a barium solution, or the doctor will give it to you as an enema. It helps check any abnormalities on the X-ray.
  • Magnetic resonance imaging (MRI). This test uses powerful magnetic and radio waves.  It creates images of the tissues with a high level of clarity.
  • Endoscopic ultrasound. This involves putting a narrow pipe and camera in the anus and bowel. The aim is to create images of the internal structure of the area with high-frequency sound waves.
  • Fistulography. The doctor introduces a contrast medium through the fistula opening to check the fistula's size and pathway on an X-ray.
  • Lowerendoscopy. The doctor inserts a flexible fiberoptic scope or endoscope into the anus and bowel to create the tissue images.

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After these tests, the doctor can decide how best to do the fistulotomy procedure and also determine if other surgical procedures are necessary.

Final Thoughts

Fistulotomy is a surgical procedure used to treat fistulas, mainly in the anal area. The process is used for simple cases, but other surgical techniques may be necessary for complicated situations. The procedure’s cure rate is high, and with proper care and healing, you can resume your normal life in a few weeks.

WebMD Medical Reference

Sources

SOURCES:

Annals of Gastroenterology: “Recent Developments in the Surgical Management of Perianal Fistula for Crohn’s Disease.”

Cedars-Sinai: “Anal Fistula,” “Fistula.”

Clinics in Colon and Rectal Surgery: “Radiographic and Endoscopic Diagnosis and Treatment of Enterocutaneous Fistulas.”

HealthDirect: “Surgery for Anal Fistula.”

Journal of the Korean Society of Coloproctology: “Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial.”

Medscape General Medicine: “Evaluation of Perianal Fistulas in Patients with Crohn’s Disease.”

National Health Service: “Anal Fistula.”

Springerplus: “Meta-Analysis of Randomized Clinical Trials Comparing Fistulectomy Versus Fistulotomy for Low Anal Fistula.”

Stanford Health Care: “Fistula Repair Procedure.”

StatPearls: “Anal Fistulotomy.”

Techniques in Coloproctology: “Fistulotomy or Fistulectomy and Primary Sphincteroplasty for Anal Fistula (FIPS): a Systematic Review.”

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