Idiopathic Anal Fistula: Fistulotomy or Fistulectomy?

A fistula has a primary tract and may have secondary extensions. Complete eradication of both may lead to cure. Layopen (fistulotomy) is the most certain treatment where it is possible and when the risks have been properly explained and accepted. Anterior fistulas in women are dangerous and should only rarely be laid open. The technique of fistulectomy, which excises rather than incises the fistula track, has been criticised on the basis of the greater tissue loss leading to delayed healing. However, fistulectomy by a core-out technique rather than excision of the track have several advocates. The paper discussed the natural history of the idiopathic anal fistula and the pros and cons of these two common modes of treatment.