Intersphincteric perianal fistulotomy
Please note that the information provided in this section is for informational purposes only and should not be used for self-diagnosis or treatment.
Intersphincteric perianal fistulectomy is a surgical procedure that involves the complete excision of an anal fistula located in the space between the internal and external anal sphincter (the intersphincteric space).
This type of fistula (intersphincteric fistula) is the most common and usually the least complex, but it requires a delicate approach due to its proximity to the muscles responsible for bowel continence.
An anal fistula is an abnormal channel that forms in the soft tissue around the anus; it typically follows a straight path with an internal opening in a rectal crypt and an external opening near the anus. It most often occurs as a complication of a perianal abscess that failed to heal completely, leaving a persistent drainage tract. Fistulas can cause pain, purulent discharge, irritation, and chronic local discomfort.
The purpose of the procedure is to completely remove the fistulous tract while minimizing the risk of sphincter damage and incontinence.
Purpose and Components of the Procedure
Objective: To provide a definitive cure for the anal fistula while preserving normal anal function and preventing recurrence.
Main Steps:
- Identification of the fistulous tract (by palpation, probing, or pelvic MRI)
- Complete excision of the fistula tract and inflamed tissues
- Preservation of the anal sphincter muscles
- Postoperative care (dressing, hygiene, and possibly drainage)
Role of the Procedure
- Curative treatment for intersphincteric fistulas
- Eliminates chronic symptoms such as discharge, pain, and inflammation
- Reduces the risk of recurrent abscesses or fistula extension
- Allows preservation of sphincter function when performed properly
Indications
- Confirmed intersphincteric anal fistula (Parks classification)
- Recurrence after a perianal abscess or untreated fistula
- Persistent symptoms: discharge, pain, perianal swelling, irritation
- Fistulas that failed to heal with conservative treatments (e.g., seton placement)
- Confirmation via MRI or endorectal ultrasound
Patient Preparation
- Consultation with a proctologist, including a thorough clinical exam and imaging (pelvic MRI or endorectal ultrasound) to precisely map the fistula anatomy
- Fasting: Avoid food and liquids for approximately 12 hours before surgery
- Bowel preparation: Use of laxatives or enemas as advised by the doctor
- Medication adjustment: Temporary discontinuation of certain drugs, such as anticoagulants, to reduce bleeding risks
- Inform the doctor about any chronic illnesses or allergies to ensure a safe procedure
Procedure
- The surgery is performed with the patient in a lateral decubitus or gynecological position. Under spinal, local, or rarely general anesthesia, the surgeon identifies the fistulous tract using a probe. The entire pathological canal is carefully excised, including inflamed or epithelialized segments.
- Preserving the integrity of the internal and external sphincter muscles is essential to avoid complications like fecal incontinence.
- Duration: Approximately 30–60 minutes depending on complexity
Postoperative Recovery
- Same-day discharge in most cases
- Strict local hygiene and warm antiseptic sitz baths
- Pain control with symptomatic medication; gentle laxatives if needed
- Daily dressing changes and periodic follow-up (7–10 days)
- Complete healing estimated at 4–6 weeks
- Return to normal activity: 5–10 days depending on progress
Intersphincteric fistulectomy is an effective and well-tolerated procedure for the treatment of perianal fistulas, offering high healing rates and low recurrence. When performed correctly, it preserves anal continence and significantly improves the patient’s quality of life.
Sources:
https://www.nhs.uk/conditions/anal-fistula/treatment/
https://emedicine.medscape.com/article/190234-guidelines#g2?form=fpf
https://www.medicoverhospitals.in/ru/articles/fistulectomy-procedure
IMPORTANT!
It is very important to note that the information in this section is not intended for self-diagnosis or treatment. If you are experiencing pain or a worsening of any condition, you must consult a physician for diagnostic investigations. Only a qualified specialist can provide an accurate diagnosis and determine the appropriate treatment.
For the most precise and consistent evaluation of test results, it is recommended to perform them in the same laboratory. This is because different laboratories may use varying methods and measurement units for similar investigations.
