Anorectal Fistulotomy

Abstract

Indication • Fistula-in-ano Essential Steps 1. Rectal exam. 2. Identify the external opening. 3. Inject local anesthetic. 4. Anoscopy/anal retraction. 5. Identify the internal opening. 6. Pass the probe from the external to internal opening. 7. Unroof the fistula. 8. Identify any sidetracks and unroof. 9. Biopsy the tract and send to pathology. 10. Hemostasis. Note These Variations • Penrose drain or seton for:-Complex fistulae-Multiple tracts-Crohn's disease Complications • Recurrent abscess/fistula • Incontinence • Bleeding • Urinary retention Template Operative Dictation Preoperative Diagnosis Fistula-in-ano Procedure Anoscopy, fistulotomy Postoperative Diagnosis Same Indications This ___-year-old male/female developed fistula-in-ano after previous incision and drainage of perirectal abscess. Description of Procedure The patient was brought to the operating room. Time-outs were performed using both preinduction and pre-incision safety checklists to verify correct patient, procedure, site, and additional critical information prior to beginning the procedure. General/spinal/monitored care anesthesia was induced. The patient was then positioned in the prone jackknife/lithotomy/left lateral decubi-tus position. The perineum was prepped and draped in the usual sterile fashion. The external opening(s) of the fistula(e) was/were identified.