Fistulotomy

A fistulotomy is a surgical procedure used to treat an anal fistula, which is an abnormal connection between the inside of the anus and the skin around it.

Indications

The primary indication for a fistulotomy is the presence of a simple anal fistula that is not complex or does not have multiple tracts. This procedure is often recommended when other treatments, such as fistula plug or fibrin glue, are not effective or suitable.

Procedure

The fistulotomy procedure typically involves the following steps:

• The patient is given general anesthesia or local anesthesia with sedation to minimize discomfort during the procedure.
• The surgeon identifies the external opening of the fistula and makes a small incision to connect it to the internal opening in the anus.
• The surgeon then opens up the fistula tract, allowing it to heal from the bottom up.
• In some cases, the surgeon may need to remove any infected tissue or debris within the fistula tract.
• The wound is left open to heal, and the patient is given instructions on how to care for the wound during the recovery period.

Types of Fistulotomy

There are different types of fistulotomy procedures, including:

• Open fistulotomy: This involves making an incision in the skin over the fistula tract and opening it up to promote healing.
• Closed fistulotomy: This involves making a small incision at the external opening of the fistula and using a specialized instrument to close the internal opening.
• Laser fistulotomy: This is a minimally invasive procedure that uses a laser to close the fistula tract.

Risks and Complications

As with any surgical procedure, there are potential risks and complications associated with fistulotomy, including:

• Bleeding or hemorrhage
• Infection
• Fecal incontinence
• Recurrence of the fistula
• Pain or discomfort during the recovery period

Recovery

The recovery period for a fistulotomy typically lasts several weeks, during which time the patient may experience some pain, swelling, and bleeding. The patient will need to follow a bowel regimen and take medications as directed by their surgeon to promote healing and prevent complications.

Success Rate

The success rate of fistulotomy varies depending on the complexity of the fistula and the individual patient's condition. In general, simple fistulas have a higher success rate than complex fistulas. The overall success rate for fistulotomy is around 80-90%.