Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Anal Fistula — Fistulotomy
Laying open a low, simple fistula track — high healing when sphincter risk is low
Fistulotomy opens the tunnel along skin and mucosa into a groove that heals from the inside out. In simple, low fistulas healing rates are often very high (commonly in the 90%+ range in series). In high tracks, cutting too much sphincter raises incontinence risk — so it is not used for every fistula.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
This educational figure shows: Fistulotomy.
Who may be a candidate?
- Low intersphincteric or low transsphincteric simple fistulas
- A single clear track with abscess pocket controlled
- Patients with adequate sphincter reserve
Step-by-step overview
- 1
Internal and external openings
The track is confirmed with probe and/or dye.
- 2
Lay-open
Tissue over the tunnel is divided so the track becomes an open wound.
- 3
Healing
The wound closes by granulation; dressings and hygiene are planned.
Key points
Aftercare essentials
Sitz baths and dressings, soft stools, and expected staining in the first weeks. Skip follow-up visits at your peril — early wound problems are easier to fix early.
- Sitz baths and wound care
- Keep stools soft
- Staining in early weeks can be normal
- Keep control appointments
- Key note inside
Continence and recurrence
In carefully selected low fistulas incontinence risk is low. Higher tracks need sphincter-sparing alternatives. Recurrence after simple fistulotomy is relatively uncommon but rises if a side branch is missed or wound care fails.
Frequently asked questions
How long does the wound take to close?
It depends on width and depth; most close over weeks from inside out. Regular dressings help prevent the surface sealing over a residual pocket.
When can I return to work?
Desk work is often possible within days to 1–2 weeks; heavy work and intense sport later. Timing follows wound size and pain.
What is urgent after fistulotomy?
High fever, rising swelling or pain, uncontrolled bleeding, or inability to urinate — seek care without delay.
More chapters in this hub
Diagnosis & anatomy
Anal Fistula Symptoms
Discharge, recurrent abscess, and urgent warning signs
What Causes an Anal Fistula?
Abscess, Crohn’s, and other triggers
Abscess and Fistula Link
Infection first, tunnel second
Anal Fistula Classification
Simple versus complex — explained for shared decisions
Anal Fistula Diagnosis
Exam, MRI mapping, and Parks classification
Complex fistula
Seton
LIFT / flap
Crohn
Newer sphincter-preserving techniques
Recovery / recurrence / continence
Appointment / info
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.