Fistulotomy Indications and Contraindications

Fistulotomy is a surgical procedure used to treat anal fistulas, a condition where an abnormal channel forms between the anal canal and the skin surrounding the anus. While this procedure is generally safe and effective, it’s important to understand the indications and contraindications before undergoing the surgery.

Indications for Fistulotomy

Fistulotomy is typically recommended for patients who have a chronic anal fistula that hasn’t responded to other treatment options, such as antibiotics, drainage procedures, or seton placement. It may also be recommended for patients who experience recurrent fistulas or have a complex fistula that requires surgical intervention.

The goal of fistulotomy is to remove the entire fistula tract, including any associated infection or abscess, and allow the wound to heal from the inside out. This can help prevent the fistula from recurring and improve the patient’s quality of life.

Contraindications for Fistulotomy

While fistulotomy can be an effective treatment option for many patients, there are certain contraindications that may make the procedure inappropriate or risky. Some contraindications include:

Active Infection

Fistulotomy may not be appropriate for patients who have an active infection, as the procedure can spread the infection to surrounding tissues and lead to complications. In such cases, it may be necessary to first treat the infection with antibiotics or drainage procedures before considering surgery.

Inflammatory Bowel Disease

Patients with inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, may not be good candidates for fistulotomy. These conditions can increase the risk of complications, such as fistula recurrence, abscess formation, or fistula branching.

Radiation Therapy

Patients who have received radiation therapy in the pelvic region may have a higher risk of complications with fistulotomy, such as delayed healing or tissue damage. In some cases, alternative treatment options may be recommended.

Advanced Age or Poor Health

In some cases, patients who are elderly or have underlying health conditions may not be good candidates for fistulotomy. This is because the procedure can be physically demanding and may increase the risk of complications.

Alternatives to Fistulotomy

For patients who are not good candidates for fistulotomy, or who prefer to explore non-surgical options, there are several alternative treatments available. Some of these include:

Seton Placement

A seton is a small piece of material, such as a rubber band or surgical thread, that is placed in the fistula tract to promote drainage and prevent infection. This may be an effective treatment option for patients who have a complex fistula or are not good candidates for surgery.

Fibrin Glue Injection

Fibrin glue is a substance made from human blood that can be injected into the fistula tract to seal off the opening and promote healing. This treatment may be recommended for patients with a simple fistula or who have a high risk of complications with surgery.

Biologic Agents

Biologic agents may be used to treat fistulas in patients with inflammatory bowel disease. These medications work by suppressing the immune system and reducing inflammation in the affected area.

Additionally, it’s important for patients to understand the potential risks and complications associated with fistulotomy. While the procedure is generally safe, there is always a risk of bleeding, infection, or damage to surrounding tissues. Patients may also experience pain or discomfort during the healing process.

To reduce the risk of complications, patients should carefully follow their doctor’s post-operative instructions, which may include taking pain medication, keeping the area clean and dry, and avoiding strenuous activities for a period of time.

In some cases, patients may also need to undergo additional procedures, such as a colostomy, if the fistula is located in a difficult-to-reach area or if the surgery results in significant damage to surrounding tissues.


Overall, fistulotomy is an effective treatment option for many patients with anal fistulas. By carefully considering the indications and contraindications, patients can work with their healthcare provider to determine the best treatment plan for their individual needs and circumstances. Whether undergoing surgery or exploring non-surgical options, it’s important to prioritize healing and follow-up care to ensure a successful outcome.