How is Fistulectomy/Fistulotomy done ? What are the advantages and disadvantages of this procedure?

Oldest and the best studied of all the methods. In this surgery, the fistula tract is laid open by cutting out the whole tract with knife [Fistulotomy] or the fistula tract is totally taken out[Fistulectomy]. The resultant wound is generally not closed and left open to heal of its own. This way the chances of recurrence are decreased.
It is considered as a good option for Low Fistulas but is not recommended for High fistulas.

ADVANTAGES

High success rates in Low Fistulas

DISADVANTAGES

• Pain-This surgery leads to a large wound from the anal opening to the buttock . Understandably this leaves the patient with lot of pain in the post operative period.
• Invasive- The procedure is associated with a lot of cutting ,scarring and distortion of anatomy.
• Long Hospitalization- The patient generally needs hospitalization for 4-8 days or even longer.
• High morbidity- The patient requires dressings for 4-6 weeks and is obviously off the work for this time.
• High recurrence rates-. In spite of all these difficulties, this surgery is associated with a high recurrence rate.
• Risk of Incontinence- The procedure has a definite risk of incontinence especially in high fistulas.