FISTULOTOMY

Operative Technique

Simple Low Fistula

Intersphincteric/Transsphincteric

Patient supine on lithotomy position/ prone on jackknife position under SAB/CLEA

Asepsis and antisepsis technique

Sterile drapes placed

Rectal speculum inserted

Internal opening located with use of probe inserted on the external opening following the fistulous tract carefully

Incision made with probe as guide starting on the external opening carried from skin through subcutaneous tissue, and division of overlying anoderm, and:

IntersphinctericFistula - internal sphincter up to the internal orifice of the fistula

Transsphincteric Fistula – external and internal sphincters up to the internal orifice of the fistula

Necrotic tissues removed by curettage

NSS wash

Hemostasis

OS packing