Fistulotomy

Anal fistulotomy, the unroofing of the entire tract from the external to the internal opening, is the most effective and simple treatment for most patients with anal fistula. However, anal fistulotomy carries a risk of fecal incontinence that is related to the loss of sphincter function and the deformity of the anal canal that results from dividing the tissue encircled by the fistula. The main treatment challenge is how to select patients who will be cured of their fistula without developing postoperative fecal incontinence. The decision should be individualized according to the proportion of the muscle involved, the location of the tract, the patient's sex, history of previous anal surgery, continence, and finally, but not less importantly, the surgeon's experience.