What is a Fistulotomy?

Analgesics may be prescribed to a patient after a fistulotomy.

Fistulotomy is a surgical procedure performed to correct anal fistulas. A fistula is a small, sometimes painful, canal that separates from the anal cavity, burrows into muscle tissue, and emerges through the skin near the anus. The only reliable treatment for fistulas is fistulotomy, and most patients diagnosed with the disease eventually need surgery to prevent serious infections and chronic symptoms. During the procedure, the surgeon opens the canal, spreads it out, scrapes out the pus and infected tissue, and sutures them to the surrounding muscle tissue to prevent recurrence. Most fistulotomy procedures can be performed in less than an hour in an outpatient surgical center and the success rate is very high.

A scalpel is a small, sharp knife used to perform surgery.

Before considering a fistulotomy, the doctor reviews the patient’s complete medical history to make sure he or she is a good candidate. People who suffer from Crohn’s disease and other irritable bowel disorders often do not respond well to surgery because their conditions make it difficult for the tissue to heal later. These patients may be prescribed antibiotics and scheduled for regular checkups to see if their fistula symptoms improve. Most other people who are generally in good health are scheduled for surgery.

Conscious sedation and local anesthetics may be administered prior to initiation of fistulotomy.

A fistulotomy involves making a small cut and probing a very sensitive and inflamed area. Most surgeons suggest that patients receive general anesthesia before their procedures to reduce pain and stress. An anesthesiologist provides sedatives and pain relievers approximately thirty minutes before the start of surgery and monitors vital signs throughout the operation to ensure the patient is comfortable. The sedated patient is usually positioned on his stomach, with the buttocks slightly elevated. The skin around the anus is then sterilized and prepared for surgery.

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General anesthesia is recommended for a fistulotomy.

A probing device is inserted into the anus and used to locate the internal opening of the fistula. Once the surgeon determines the exact size, location, and course of the fistula, he or she can begin opening it up with a scalpel or cauterization tool. Depending on the location, it may be necessary to cut through the sphincter muscle wall to gain access. Pus, fecal waste, and debris from dead and inflamed tissue are carefully scraped from the fistula. The remaining tissue is often sutured or glued to the sphincter to ensure the fistula reappears.

Like all surgical procedures, fistulotomy can cause infection or other complications.

After a fistulotomy, topical antibiotics and dressings are applied to prevent bleeding and infection. The patient is taken to a recovery room until the anesthesia wears off. He is usually prescribed antibiotics and pain relievers and given instructions on how to care for surgical wounds at home. A person can expect some discomfort when sitting and having a bowel movement for about a month during recovery. A follow-up medical appointment can confirm that the procedure was successful and that healing is taking place.

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