Chapter 29 Anal Fistulotomy
INDICATIONS
Although not all surgically drained perianal or perirectal abscesses will result in a chronic fistula-in-ano, it is estimated that as many as 50% will.1 The symptoms of a persistent fistula include recurrent abscess formation, chronic perianal drainage, and pain. The diagnosis of a persistent fistula-in-ano in most patients is an indication for consideration of fistulotomy to reduce or eliminate these chronic symptoms and the frequency of recurrent abscess formation. Notable exceptions would include patients with complex fistulas due to Crohn’s disease, perineal radiation, or uncontrolled distal gastrointestinal tract or gynecologic malignancy.
OPERATIVE PROCEDURE
Anesthetic Considerations
Urinary Retention
Urinary retention is one of the most common complications of all anorectal surgery. The extent and complexity of surgery correlates with the incidence of this complication. A large institutional study has reported the incidence of urinary retention after fistula surgery as 5%.2
• Consequences
• Repair
• Prevention
Examination under Anesthesia and Identification of the Internal Opening
Failure to Identify the Internal Opening
• Consequence
• Repair
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