Colorectal

Fistulotomy (Fistula-in-Ano)

FISTULOTOMY (FISTULA-IN-ANO)

Indication: Simple intersphincteric or low transsphincteric fistula-in-ano in a patient with normal continence. Primary fistulotomy is appropriate only when the amount of sphincter muscle overlying the fistula tract is minimal and continence risk is low.

Patient Position: Lithotomy.

Anaesthesia: General or spinal.

Procedure:
1. Examination under anaesthesia. Fistula tract delineated: external opening(s) identified. Goodsall's rule applied to predict course.
2. Proctoscopy and fistula probe used to identify the internal opening at the dentate line.