Fistulotomy vs Fistulectomy: What's the Difference?

A fistulotomy is a procedure that is used to treat fistula. This can be used as an alternative to a fistulectomy, both of which have specific advantages and disadvantages. Understanding the difference is important for patients who want to make the best, informed choice about their treatment. Read on, and we will explore the differences and what you need to know, in more depth.

What is a Fistula, and Why Do You Need Treatment for It?

A fistula is a condition characterized by the abnormal connection of two organs or vessels. This is commonly found in a number of specific areas, including:

• Urinary tract
• Aorta
• Vagina
• Skin
• Intestines
• Anus

For example, a common anal fistula will see the perianal skin (the skin around the anus) forming to connect with the surface of the anal canal. This can lead to an anorectal fistula, which is a connection between the anal canal and surrounding opening. A rectovaginal fistula sees a hole develop between the vagina and the rectum.

This can prevent proper movement and function of one or both organs and as such, a surgical procedure is recommended to disconnect the two and remove the tissues.

Treatment Approaches

When treating a fistula, patients and doctors have the choice between a fistulotomy or a fistulectomy.

Fistulotomy is usually an outpatient procedure, meaning that it can be carried out in a single day and doesn’t require a hospital stay. This process takes roughly an hour, but of course, there will be the time leading up to and following the procedure.

The nature of the procedure of course also depends somewhat on the extent of the fistula. If the fistula is small and shallow, doctors can often perform the procedure in their office using local anesthesia. If the fistula is large, however, then you might require a general anesthetic, which requires a trip to the hospital.

To perform the fistulotomy, the doctor or surgeon will make a small incision in order to sever the abnormal connection between two organs. This allows the organs to move and behave freely and is a very moderate procedure that is not highly invasive for the patient. Of course, it doesn’t actually remove any tissue, however, meaning that the two “ends” will still be attached to their respective organs.

In some relatively rare cases, the doctor might be required to cut a small amount of the anal sphincter muscle during the procedure. This can in some cases lead to incontinence, though doctors will be extremely careful to avoid this possibility.

A fistulectomy is a procedure that fully removes the fistulous tract. This increases the likelihood of damage to the sphincters and is therefore often not preferred. However, this may be necessary if there is a large amount of tissue that is blocking normal function, or if there is a high likelihood of recurrence.

Other Procedures

There are actually a number of other similar procedures that may be more appropriate to the specific case or used in conjunction with the fistulotomy/fistulectomy. For example, the seton technique involves using a small amount of surgical thread that is left inside the fistula for several weeks. This keeps it open and ensures that when the healing occurs, it doesn’t close over again. This can also allow the fistula to drain. It can often avoid the need for cutting the sphincter muscles.

In some cases, tight setons might be needed, which may require multiple smaller procedures.

Advancement flaps can be necessary if the fistula passes through sphincter muscles and fistulotomy is too high risk. Here, the fistula will be cut or scraped out, while the hole that it entered is covered using a flap of tissue taken from the inside of the rectum.

This has a slightly low success rate but reduces the risk of complications.

The LIFT procedure involves a small cut above the fistula, before moving apart from the sphincter muscles. The fistula will then be sealed at both ends and then cut open so that it lies flat. This is a relatively new procedure and more data needs to be collected. However, it is showing promise.

Endoscopic ablation uses a small tube with a camera to inspect the fistula. An electrode will then be passed through the endoscope to seal the fistula. This has been shown to be effective with a relatively minor risk of complications.

Laser surgery uses a radial emission of lasers to seal the fistula. Fibrin glue is the only non-surgical option and involves injecting glue into the fistula while the patient is under general anesthetic. This will seal the fistula to encourage healing. It is less effective than fistulotomy and may only be temporary. But it can prevent surgery.

There are many different options for treating this uncomfortable condition, but your surgeon or doctor should be able to talk you through the best options for you.