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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Operative

Fistulectomy

A close cousin of fistulotomy — instead of laying the fistula tunnel open, the whole tract is removed, leaving an open wound that heals from the inside out.

Request a consultationSurgery is arranged with a coordinator by phone.
Setting
Operative
Anesthesia
General or spinal anesthesia in the operating room, typically as a same-day (outpatient) procedure
Back to work
Most patients are back to desk work and non-strenuous activity within about a week
Pain relief
Warm sitz baths, stool softeners, and oral pain medicine for the first several days
Success rate
85-95%
Recurrence
5-15%

What it is

What is a Fistulectomy?

A fistulectomy is a surgical procedure for the treatment of an anal fistula that involves the complete excision of the fistula tract. This procedure converts the subcutaneous tunnel into an open wound, which then heals from the inside out over several weeks. The goal is to completely remove the fistula tract to prevent recurrence, while preserving the integrity of the anal sphincter muscles to maintain fecal continence.

Am I a candidate?

Who is a Good Candidate for a Fistulectomy?

A fistulectomy is most suitable for patients with simple anal fistulas, where the tract involves a minimal portion of the sphincter muscle (low transsphincteric, intersphincteric, or subcutaneous). This approach allows for the complete removal of the fistula tract without a significant risk of compromising continence. It is generally not recommended for complex fistulas that involve a large portion of the sphincter muscle, as this would carry an unacceptably high risk of incontinence.

How it's done

  1. 1Under anesthesia, a thin probe is passed through the fistula tunnel to map exactly where it runs.
  2. 2Rather than opening the tunnel, the tract itself is cut out in its entirety — removing the infected lining along with it.
  3. 3Because the whole tract comes out, the wound is a little larger than after a fistulotomy.
  4. 4The wound is left open on purpose so it heals from the bottom up.
  5. 5Most patients go home the same day.

What to expect

  1. Same day

    Home once the anesthesia wears off, with a small dressing.

  2. First few days

    The sorest stretch. Warm sitz baths after bowel movements are the mainstay of comfort. Keep stools soft with fiber and fluids.

  3. About a week

    Most patients are back to desk work and non-strenuous activity.

  4. Weeks 2–8

    The open wound fills in from the bottom up. Drainage tapers off; complete healing commonly takes six to eight weeks.

  5. Follow-up

    Wound checks to confirm it heals from the base up, not by sealing over the surface.

Risks & considerations

What are the Risks?

While effective for simple fistulas, a fistulectomy has potential risks, including:

  • Pain: Postoperative pain is expected and is typically managed with sitz baths, stool softeners, and oral pain medications.
  • Bleeding: Minor bleeding, especially with bowel movements, is common. Significant bleeding is rare.
  • Infection: The wound can become infected, though this is uncommon.
  • Fecal Incontinence: There is a risk of new or worsened incontinence to gas or stool, particularly if a significant amount of sphincter muscle is involved or damaged during the excision.
  • Recurrence: The fistula can recur if the tract is not completely excised or if there are unidentified secondary tracts.

Sources

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