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The fistula is the tunnel that forms under the skin and connects the clogged infected glands to an abscess. In this procedure, the internal opening of the fistula is covered over by healthy, native tissue in an attempt to close the point of origin of the fistula. This procedure involves division of the fistula tract in the space between the internal and external sphincter muscles. The perianal area is the most frequent and the supralevator the least. Pain after surgery is controlled with pain pills, fiber and bulk laxatives. If the fistula is straightforward involving minimal sphincter muscle , a fistulotomy may be performed. The plug also has the advantage of not requiring division of the sphincter muscle. When diagnosing an anal fistula, an external opening that drains pus, blood or stool is usually seen on examination. This procedure involves unroofing the tract, thereby connecting the internal opening within the anal canal to the external opening and creating a groove that will heal from the inside out. As mentioned above, if a significant amount of sphincter musculature is involved in the fistula tract, a fistulotomy may not be recommended as the initial procedure.
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