Fistulotomy
- Identify both the external and the internal openings of the fistula. Connect them with a probe to identify the tract.
- If the internal opening cannot be found, it may be necessary to use methylene blue or hydrogen peroxide to identify the internal opening.
- Appreciate the fistula tract's relationship to the sphincter complexes and be able to open it in an appropriate surgical manner.
- The goal is to maximize sphincter preservation and take care not to probe too hard and risk creating a false passage.
- Feel the amount of muscle overlying the probe prior to dividing the isolated tissue.
- It is acceptable to divide the internal sphincter; however, care should be taken to divide as little external sphincter as possible.
- Marsupialize the edges of the wound once the fistula has been opened.
- If a fistulotomy cannot be performed because of sphincter involvement, a seton is indicated.