Editing Anal fistula surgery (section)

=== '''Fistulotomy''' ===

* Balance     between curing the acute problem, and causing incontinence later in life
* High-risk     factors for incontinence:
** 12 o'clock      tract, especially in women
** Involving      >20% of external sphincter (traditionally, dividing internal sphincter      is not as risky)
** Poor pre-op      sphincter function
* Good     candidates for fistulotomy:
** Posterior
** Superficial
** Inter-sphincteric
** Consider it      for low trans-sphincteric, but there will always be a risk of impaired      sphincter function
* Cannulate     and divide tissue over probe
* Recurrence     rate for these will be 2-8%, with functional impairment 0-17%
** ~30% risk      of flatus and mucus incontinence