Fistulotomy

A fistulotomy works by gently opening up the fistula tract — the small tunnel that has formed — from its inside opening to its outside opening on the skin. Once laid open, the wound heals from the base upward, like a graze healing over, and the tunnel is gone for good. This approach works well when the fistula runs through only a small amount of the sphincter muscle (the muscle ring that gives you control over your bowel). Before deciding that a fistulotomy is right for you, a special scan called an endoanal ultrasound — a well-tolerated internal scan — is arranged so the exact path of your fistula, and how much muscle is involved, can be mapped accurately. Choosing the right operation for your anatomy is everything.

• A low intersphincteric fistula — one that passes between the inner layers of the sphincter muscle, staying well clear of the main muscle bulk
• A low transsphincteric fistula — one that crosses through the outer sphincter muscle, but only through a small portion (less than 30%) of it
• A very shallow (superficial or subcutaneous) fistula close to the skin surface
• A fistula that has not closed after an earlier seton (a temporary thread drain) was removed
• A straightforward fistula in someone whose sphincter muscle has not been injured before
• A fistula that developed after a perianal abscess, provided the anatomy is favourable

• High cure rate — in published series, a single fistulotomy permanently fixes the majority of low fistulas, with recurrence typically reported in the 5–10% range
• Usually just one operation is all you need
• Nothing foreign is left inside your body — no plugs, no glue, no implants
• The tissue removed is sent to the laboratory (histology) to make sure there is no underlying condition such as Crohn's disease
• A day procedure — you go home the same day; no overnight hospital stay needed

• Bowel control (faecal incontinence): This is the most important risk to understand, and it will be discussed with you in detail at consultation. For truly low fistulas — where the tunnel barely touches the sphincter muscle — published series report a risk of around 5–15% (including minor disturbance to wind control). The risk is higher if more muscle is involved, which is exactly why careful scanning before surgery matters so much. If there is any doubt, a different, muscle-sparing approach (such as a seton, LIFT, or mucosal advancement flap) is recommended instead.
• Wound healing time: The wound is left open to heal naturally from the inside out — think of it like a graze. This is deliberate and is actually how the fistula closes for good. For most low fistulas, healing takes 4–8 weeks. It can feel slow, but steady progress is normal.
• Recurrence: Roughly 5–10 in 100 low fistulas come back after fistulotomy. If yours does, further treatment options (a repeat fistulotomy, seton, LIFT, or flap) are available.
• Bleeding: Some bleeding around the wound in the first few days is normal and usually minor. Heavy bleeding is uncommon.
• Pain during healing: The area will be sore, especially in the first week. Warm sitz baths (sitting in a shallow bath of warm water) and regular pain relief make a real difference.
• Minor change in anal shape: As the wound heals, a small groove or notch may form at the site — this is a cosmetic change only and does not affect how the bowel works.

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guide above.

• An endoanal ultrasound (a small internal scan) or MRI scan to map your fistula precisely — this is essential before any decision is made about surgery
• No bowel preparation needed — you do not need to take laxatives or undergo an enema beforehand
• A thorough consent conversation at consultation, where the risk of incontinence specific to your anatomy will be explained in plain language

• You will be admitted to the day-surgery unit at Warringal Private Hospital or Epworth Eastern on the morning of your procedure and given a general anaesthetic — you will be completely asleep and feel nothing during the operation
• A thin probe is gently passed through the fistula tunnel to map its course from the inside opening to the outside opening on your skin
• The tunnel is then opened along its length using a precise surgical tool, converting it into a shallow open groove
• The tissue lining the groove is sent to the laboratory to check for any underlying condition
• Local anaesthetic is injected into the area to keep you comfortable when you wake up
• You recover in the day-stay unit for a few hours, then go home with written instructions on how to look after your wound

• Days 1–2: The area will be sore — this is completely expected. Take your pain relief regularly (do not wait until you are in pain to take it), and sit in a warm shallow bath (a sitz bath) a couple of times a day. This soothes the wound and keeps it clean.
• Days 3–7: Pain should start easing. It is important to gently irrigate (rinse) the wound as instructed — keeping it clean helps it heal from the inside out. You will be shown exactly how to do this before you leave hospital.
• 4–8 weeks: Most low fistulas are fully healed within this window. Progress is gradual — you will notice the groove slowly becoming shallower week by week.
• Eat plenty of fibre (fruits, vegetables, wholegrains) and drink enough water throughout your recovery. Soft, easy-to-pass stools reduce discomfort and protect the healing wound.
• Call the rooms if you develop a fever, notice worsening rather than improving pain, or the wound looks like it is opening up rather than closing — these are signs worth checking promptly.
• A post-operative review is routinely arranged 2–6 weeks after your operation, with timing depending on the type of surgery — this review is provided at no charge.
• For day-by-day instructions on sitz baths, wound irrigation, pain control, and what to watch for, see the Post-anal-procedure aftercare guide on the Resources page.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.