What Happens During a Fistulotomy?

Anal fistula patient with constant pain which gets worse with cough, sitting down, moving around, and defecation.

An anal fistula is a small tunnel or opening that develops between the end of the anus and near the anal skin (where poop/feces leaves the body). An anal fistula usually develops due to infection and the collection of pus near the anal area. Presence of anal fistula may be unpleasant due to the following symptoms:

• Constant pain which gets worse with cough, sitting down, moving around, and defecation (poop discharge)
• Skin irritation around the anus
• Smelly discharge near the anus 
• Passing pus or blood during poop discharge
• Swelling and redness around the anus
• Fever due to the presence of pus near the anus
• Difficulty controlling bowel movements (bowel incontinence)

An anal fistulotomy is a surgery that opens and drains an anal fistula, helping the fistula heal. It is the best treatment for anal fistula.

A fistulotomy is a surgical procedure that opens and drains the fistula, so that the area can heal. It also closes the infected tract. It is usually done as an outpatient procedure, so an overnight stay in the hospital usually is not needed. If the fistula is not deep or large, fistulotomy may be done in the doctor’s office under local anesthesia. In this situation, the procedure may take about an hour. For larger or deeper fistulas, it may be done in the hospital under general anesthesia.

During the fistulotomy, a cut will be made at the site of the fistula. The fistula is opened surgically to remove the infected area with pus or other fluids. In many cases, stitches are used during a fistulotomy. If stitches aren’t used, the wound would be left open and either packed or covered with gauze.

Potential complications after fistulotomy include:

• Anesthesia complications, like headache and drowsiness
• Post-surgical pain
• Fever
• Potential loss of bowel control (bowel incontinence)
• Bleeding
• Recurrence of fistula with pus

The surgeon usually provides instructions after the procedure, which may be based on the size of the fistula. A patient may need to follow these instructions after the procedure:

• It is important to keep the area clean.
• Changing the dressing as needed at regular intervals. Some fistulas that are left open may need to be packed with gauze and this gauze will need to be changed often to keep the area clean.
• In the case of anal fistulas, sitz baths (in which a person sits hip-deep in the water to bathe) might also be recommended during the healing process.
• There may be medications prescribed such as pain medications, stool softeners or fiber supplements. Antibiotics may also be given. ?
• There may be a few follow-up appointments with the doctor to check the healing process.

A fistula is a serious and unpleasant condition and, if left untreated, can lead to long-term complications. The success rate of a fistulotomy varies, based on several factors. However, according to the American Society of Colorectal Surgeons, it can be as high as 92% to 97% for treating anal fistulas. Treating a fistula with surgery can be effective, but it is important to follow instructions after the procedure carefully, and to see the doctor right away if any complications arise.