Fistulotomy

Abstract

This chapter will discuss principally the risk of anal incontinence after fistulotomy. The published risk of incontinence varies from 0% to over 70%, a spread that is entirely illogical. Among 15 randomized trials that have at least one fistulotomy arm, wherein data are collected prospectively and without selection bias, only one case of fecal incontinence has been reported. The remaining incontinence was described as “minor”, which means to flatus and anal seepage, both being normal events in anorectal wound healing. In any case the risk has varied from 0% to a maximum of 10%. No studies have been published specifically discussing the treatment of fistulotomy related incontinence. Other complications of fistulotomy described herein are the failure to recognize cancer or Crohn’s disease in the fistula, the failure to find an internal opening of the fistula and its consequences, and the non-healing anal wound.