When an anal fistula has developed and the course or the tract of the fistula has been determined from the anal canal to the perianal skin, and the surgeon has reassured themselves that there is not much anal muscle below the fistula, in the expectation that with its division no anal or faecal incontinence will result, then a fistulotomy may be performed. This is fortunately the case for most fistula that present. A fistulotomy usually involves dividing the skin, fat and muscle between the skin and the two fistula openings, down to the tract of the fistula as it courses through the perianal and anal muscle tissues. This is achieved with either a scalpel or an electrocautery device.

Depending on the type of fistula and wound, the surgeon may leave the resulting would open or “marsupialise” (stitch the opened fistula tract to the skin edges) the wound with dissolvable sutures to aid wound healing.

You will be given specific instructions on the day of surgery, but they usually include regular warm salt or sitz baths, avoiding hard wiping of the area, the use of perianal pads, and taking of stool softeners, pain medicine, fibre supplements and possibly a laxative. A nerve block in the area provides decent pain relief on the day, and medications will be given to hopefully minimise pain or any ongoing discomfort.
Following surgery there are risks of bleeding and infection, and longer term risks of inability to control flatus of bowel movements, but it is best to discuss these with your doctor for more specific details related to your fistula and your planned surgery.

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