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When an abnormal connection between two organs or blood vessels is formed, it is called a fistula. It is an ‘abnormal’ connection between organs or vessels because these would not be connected otherwise in normal conditions. A fistula can form in any part of the body, such as the urinary tract, anus, intestines, aorta, vagina, and skin. Among these, fistulas of the urinary tract and anal fistulas are more common. Fistulotomy is a surgery that is performed to treat fistulas.


A fistula can develop in any part of the body due to infection, inflammation, surgery, or an injury. There are many ways of treating a fistula, and Fistulotomy is one of them. This procedure can be performed in a doctor’s office, but larger fistulas usually need to be operated under anaesthesia. A Fistulotomy is often confused with a Fistulectomy. In a Fistulectomy, doctors remove a fistula along with the surrounding tissues.

In a Fistulotomy procedure, the pus and fluid accumulated in the affected tissues are drained. This enables healing of the tissues and closes the abnormal opening between the organs. A Fistulotomy procedure has a very high success rate, but complex fistula cases require additional procedures.

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What are the Causes That Require a Fistulectomy?

Some common causes that lead to the formation of a Fistula and require a fistulotomy are:

  • ● Naturally occurring fistula
  • ● As a result of injuries
  • ● Surgery
  • ● Gastrointestinal diseases like Crohn’s disease, colitis, IBS (Irritable Bowel Syndrome)
  • Childbirth

What are the Symptoms of a Fistula?

The symptoms of a fistula depend upon its location. For example, symptoms of an anal fistula are:

  • ● Irritation and reddening of the skin around the anus
  • ● Pain in the anal region that increases on sitting, coughing, walking
  • ● Fever with chills
  • ● Rectal bleeding and painful bowel movements
  • ● Bad smell around the anal region
  • ● Malaise and fatigue
  • ● Pus discharge from around the anus.

In the case of intestinal fistulas, the symptoms experienced by the patient include:

  • ● Pain in the affected area and around the genital-anal area
  • ● Frequent urinary tract infections
  • ● Bloating and gas
  • ● Diarrhoea
  • ● Unexplained weight loss
  • ● Inability to control bowel movements

People suffering from a urinary tract fistula show the following symptoms that are often helpful  in diagnosing their condition:

  • ● Pain while urinating
  • ● Increased frequency of urination
  • ● Foul-smelling urine
  • ● Cloudy or mud-coloured urine
  • ● Passing of stools while urinating due to poor bowel control

How is Fistulotomy Diagnosed?

Based on the symptoms of the patient and other diagnostic tests that are performed, doctors can diagnose the type and extent of one’s fistula. This also helps them decide what kind of procedure the patient requires.

When the fistula is very small and shallow, the surgeon can perform the Fistulotomy under local anaesthesia. However, a large fistula may require anaesthesia.

How is Fistula Treated Using Fistulotomy ?

During a Fistulotomy procedure, the doctor essentially opens and drains the fistula of the accumulated pus and fluid to allow the tissues to heal and close the fistula. This procedure is usually performed under local anaesthesia if the fistula is not too large or deep. However, the wound may be left open, or if a large incision is made, it may need stitches.

In the case of deeper and larger fistulas, a Fistulotomy may be performed under anaesthesia and require hospital admission.

What are the Result of Fistulotomy Procedure?

In most cases, the healing of a fistula following a Fistulotomy procedure is uneventful, but the patient must take utmost care of the wound. Anal fistulas have a recovery rate of 92% to 97% after a Fistulotomy procedure.

Following a Fistulotomy procedure, the doctor will pack the wound with clean gauze and instruct you about cleaning it. You must avoid strenuous exercises or lifting heavy weights for around 5 to 7 days after the procedure. You need to rest and eat a healthy diet during your recovery period. It can take from 3 to 12 weeks for healing post a Fistulotomy procedure.

Your doctor may also prescribe oral or topical antibiotics to reduce the chances of infection. In addition, the patient will get a prescription with pain relief medications.

What are the Result of Fistulotomy Procedure?

In many cases, complications can arise following a Fistulotomy procedure in the recovery phase. Some risks of a Fistulotomy surgery include:

  • ● Relapse of the fistula due to improper healing of the wound (the wound must heal from inside out)
  • ● Fever
  • ● Loss of bowel control
  • ● Post-surgical bleeding from the wound
  • ● Pus formation around the wound
  • ● Inability to urinate
  • ● Constipation for more than three days
  • ● Nausea and vomiting

Despite all the precautions and care post-fistulotomy, there are chances of a recurrence of the fistula.

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How Long Does a Fistulotomy Procedure Take?

Small fistulas that are shallow can be treated in your doctor’s office under local anaesthesia. This procedure takes about an hour to complete and is performed on an outpatient basis. However, hospital admission may be required when the fistulas are larger, deeper or more complicated.

Do I Need to be Admitted to a Hospital for a Fistulotomy?

For small fistulas, a Fistulotomy is performed as an outpatient procedure and does not require hospital admission. However, for more complex cases, hospital admission may be needed. This is usually determined by the preliminary diagnosis made by the doctor.

When can I get Back to Normal Activities After a Fistulotomy Procedure?

Immediately after a Fistulotomy procedure, you will need to rest completely. You must avoid strenuous activity and lifting heavy weights for at least 5 to 7 days. You can resume your normal activities gradually around 1 to 2 weeks after the surgery.

Can I Get a Fistula Again After a Fistulotomy Procedure?

Despite a successful Fistulotomy and all the post-operative care, fistulas tend to return. Therefore, you must consult with your doctor about your anxiety and fear of recurring fistula.

Can a Fistula Heal by Itself Without a Fistulotomy?

Unfortunately, a fistula once formed needs medical intervention. A Fistulotomy is a popular method of treating fistulas. But there are other techniques include non-invasive measures like fibrin glue, plugs, catheters, Fistulectomy, a laparoscopic or transabdominal surgery.
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