One of five fistula operations · see all techniques
Fistulotomy and fistulectomy: the highest-cure operation for simple, superficial fistula
Fistulotomy lays a superficial fistula tract open along its whole length so it heals from the base up; fistulectomy removes a mature, fibrosed tract instead. Both suit early or simple superficial tracts that involve little sphincter muscle, and both carry the highest published cure rate. Day-care; desk work in 3–7 days (results vary). Performed by Dr. Kundan Kharde at Sharvari Hospital, Pimple Nilakh, Pune — 5 min from Wakad.
Fistulotomy & fistulectomy is one of five operations Dr. Kundan Kharde uses; which one suits your tract is decided after imaging, and the full programme — every technique, the cost table and the FAQs — sits on our fistula treatment in Pune page.
Who is this operation for?
These are the first two rows of Dr. Kharde's framework. An early, simple, superficial tract is laid open (fistulotomy). A mature, fibrosed superficial tract is removed whole (fistulectomy), because a hardened tunnel that is only opened tends to recur. Neither is used beyond 30–50% of the external sphincter — that tract needs a sphincter-preserving operation. Almost every fistula at Sharvari Hospital is imaged before surgery — MRI fistulogram or trans-rectal ultrasound — and the tract on that scan decides the operation (how Dr. Kharde decides).
How is it done?
- Anaesthesia and probing. Spinal or short general anaesthesia; a probe confirms the path seen on imaging.
- Lay-open (fistulotomy). The tissue over the probe — skin and the few sphincter fibres the imaging has shown — is divided, opening the tract into a shallow groove.
- Or excision (fistulectomy). For a fibrosed tract, the whole tunnel is cut out as a strip.
- Curettage and marsupialisation. Granulation is scraped away and the wound edges stitched to the base so it heals faster.
- Dressing. The wound is left open to heal from below; the bulk of the external sphincter is untouched.
About 20–40 minutes · an open wound the length of the tract · the bulk of the external sphincter preserved.
What does recovery look like?
| Day | Discharge & follow-up | Dressing & bowel movement | Return to work |
|---|---|---|---|
| Day 1 | Same-day discharge after observation; walking and normal diet that evening. | Open wound, light dressing; dressing routine taught; first bowel movement next day with a stool softener. | Rest at home; antibiotics and painkillers as prescribed. |
| Day 7 | Free first review at the hospital. | Twice-daily sitz baths; dressing after each bowel movement; the wound is checked to be healing from the base. | Desk work from Day 3–7; avoid gym and cycling (results vary). |
| Day 30 | Healing review; fistulotomy wound usually closed, fistulectomy may need a few more weeks. | Wound shallow and dry; minor early change in gas control usually settled. | Resume gym, cycling and long sitting. |
Same 30-day roadmap as the main fistula page. Results vary.
What are the risks and the alternatives?
- •Bleeding: minor spotting is usual; heavy bleeding is uncommon and is an emergency (we are open 24×7).
- •Infection: fever, rising pain or new swelling needs review; antibiotics are prescribed routinely.
- •Non-healing or recurrence: published series report healing in roughly 90–95% of simple superficial tracts (literature range, not Sharvari data) — the highest of any technique. Failure is usually a missed branch or a bridged wound; results vary.
- •Continence change: low risk when the tract is truly superficial; some patients notice minor early changes in gas control. The risk rises steeply with the amount of sphincter divided — hence imaging first and the 30–50% threshold.
- • Alternatives: LIFT, FiLaC (laser), VAAFT, Seton (staged) — the imaging decides which.
Technique selection follows the ASCRS Clinical Practice Guideline for Anorectal Abscess, Fistula-in-Ano and Rectovaginal Fistula (2022).
How does Fistulotomy & fistulectomy compare?
Fistulotomy is the benchmark the sphincter-preserving operations are measured against: highest published healing, at the price of a little divided muscle.
| Technique | Best for | Sphincter cut? | Day-care? | Typical return to desk work | Published healing range* | Recurrence risk |
|---|---|---|---|---|---|---|
| Fistulotomy / fistulectomy (this page) | Simple, superficial tract, <30% sphincter | Yes, minimal | Yes | 3–7 days | ~90–95% | Low |
| LIFT | Trans-sphincteric tract; intact sphincter needed | No | Yes | 5–10 days | ~60–80% | Moderate |
| FiLaC (laser) | Trans-sphincteric tract; patient wants no cut | No | Yes | 2–5 days | ~60–70% | Moderate |
| VAAFT | Complex / branched tract, unclear internal opening | No | Yes | 3–7 days | ~70–80% | Moderate |
| Seton (staged) | Active sepsis; high / recurrent / horseshoe; Crohn's | No (drainage) | Yes (stage 1) | 2–5 days per stage | Bridge to definitive operation | n/a |
*Published literature ranges, not Sharvari outcome data; results vary and depend on tract anatomy.
Why have it at Sharvari Hospital?
- ✓Routine pre-operative imaging — MRI fistulogram or trans-rectal ultrasound for almost every fistula.
- ✓Same surgeon consults and operates — Dr. Kundan Kharde, MS, FMAS, 19+ years, 6,000+ surgeries (Dr Kharde's fistula profile).
- ✓Our own 50-bed hospital, open 24×7 — in-house beds if anything needs observation.
- ✓Cashless with 50+ insurers — pre-authorisation by our TPA desk. ISO 9001:2015 · PCMC Reg. 884.
Frequently asked questions
Why does fistulotomy have the highest cure rate? +
Because it removes the problem rather than sealing it: the whole tunnel is opened or excised, so no lining is left to re-form. Published series report healing in about 90–95% of simple tracts (literature range, not Sharvari data). The trade-off is an open wound and a little divided muscle; results vary.
Will fistulotomy affect bowel control? +
It should not when the tract is genuinely superficial — which is why it is reserved for tracts involving less than about 30% of the external sphincter and never used beyond 50%, measured on the pre-operative MRI or ultrasound rather than guessed on the table. Minor, temporary changes in gas control can occur.
Fistulotomy or fistulectomy — what is the difference? +
Fistulotomy opens the tract and leaves a shallow groove that heals in; fistulectomy cuts the whole tract out as a strip. Fistulotomy heals faster and suits an early, soft tract. Fistulectomy suits a mature, hardened tract that would recur if only opened; its wound is larger.
How long is the wound open? +
A fistulotomy wound usually closes over 3–5 weeks, a fistulectomy wound over 4–6 weeks, healing from the base upwards. Twice-daily sitz baths and a dressing after each bowel movement stop the surface bridging over too early. Desk work is possible well before closure; healing time varies with tract length.
When is fistulotomy NOT recommended? +
When the tract crosses more than 30–50% of the external sphincter, sits high or anteriorly in a woman, is recurrent, branched or horseshoe, or is linked to Crohn's disease or weak control. Those tracts get LIFT, FiLaC, VAAFT or a staged seton plan.
Cost, insurance and beds: see the full fistula treatment page.
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