Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial

Therefore, the fistulotomy is regarded as the standard treatment for simple anal fistulae and is the most widely-performed procedure. Although whether to perform a fistulotomy or a fistulectomy may be controversial, the fistulotomy is thought to be preferable because healing times are significantly shorter whereas recurrence rates are comparable. Compared with the fistulotomy, the fistulectomy is slightly more demanding, especially when the tract has ill-defined walls, because more damage is caused to the tissues surrounding the fistula tracts. A randomized controlled study comparing the fistulectomy with the fistulotomy revealed more sphincter defects in the fistulectomy group [1]. The fistulectomy has a potential advantage over the fistulotomy only when the fistula tract has not been explored via probing. Marsupialization after anal fistula surgery is postulated to leave less raw unepithelialized tissue in the fistulotomy wound, thereby resulting in less postoperative blood loss and faster wound healing [2, 3]. However, this added procedure cannot prevent postoperative deformity and showed no improved functional outcome. Marsupialization is not regarded as an essential procedure even though it can facilitate faster wound healing. Therefore, whether to implement marsupialization over a fistulotomy depends on the surgeon’s preference. In spite of the limitations of sphincter division, a fistulotomy with or without marsupialization is considered to be a very effective and safe procedure. Particularly in low, simple-type fistulae, the fistulotomy is the most widely-performed procedure.