Fistulectomy

Based on guidelines published by the American Society of Colon and Rectal Surgery (ASCRS) in 2016, simple and complex anal fistulas were to be treated by fistulotomy or rubber band seton placement with fistulectomies being a secondary option. Fistulectomy can be considered in non-anorectal fistulas as well. In these circumstances, a fistulectomy may be the best option for the removal of a patient's diseased soft tissue. == Procedure Steps ==

For anorectal fistulae, the surgeon begins by identifying the internal and external opening of the fistula. The external opening is usually on the patient's skin and can be identified in clinic. The internal opening is within the anus, and can be found while the surgeon examines the anorectal columns while the patient is under anesthesia. A methylene blue dye or a peroxide solution may be used to aid with this process. Once the openings of the tract are found, a thin metal probe is strung through. Using scissors or electrocautery, the surgeon then cores out the tunneling tract. At this point, the surgeon inspects the anal sphincters and closes any defects that were made during the procedure. The wound can then be left open to heal or closed by approximating the tissue back to its anatomic position with sutures. == Possible Complications ==

As described above, when a fistulectomy is performed to remove an anorectal fistula tract that involves the anal sphincters, a common complication that may occur is fecal incontinence. As with other surgeries, fistulectomies may also pose other complications such as delayed wound healing and infection. ==See also==