Fistulotomy or “laying open” usually cures the problem. It refers to cutting the tissue over the fistula or ” tunnel”, so there is no longer a tunnel or communication between the anal canal and skin on the outside.
A fistula may be considered “safe” to lay open if it doesn’t involve cutting much muscle. Curing a fistula is the balance between getting rid of it all together, and maintaining adequate continence or control of stool and flatus.
Your surgeon will assess weather a fistula is amenable to this operation. This will be assessed with physical examination (working out how much muscle is above the fistula, and where the internal opening or “hole” is), and sometimes an ultrasound is done to assess the rest of the muscle and how well it is working.
The operation is usually performed under general anaesthetic, and as a day case. Sometimes a flexible sigmoidoscopy or colonoscopy will be performed at the same time or later to rule out other colonic pathology which may be associated with the fistula.
If the amount of skin or tissue cut is significant, sometimes the skin is stitched flat or “marsupialised” to allow faster healing and easier dressings. Some surgeons arrange a community nurse to do dressing, others prefer the patient to digitate or “rub” the wound a few times a day to stimulate growth and clean the wound. The digitation is done with some K-Y jelly or jelly with local anaesthetic in it such as Lignocaine jelly. A gauze can be used on the finger as it has a roughness that can clean the wound.
These wound may take 4-6 weeks to fully heal over.