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Rectal Fistulotomy


A rectal fistulotomy is surgery to heal a fistula near your anus. A rectal fistula is a tunnel-like wound that forms next to your anus, often after you have an abscess (pus buildup under your skin). It spreads from inside your rectum to the skin surface near your anus. A rectal fistulotomy opens and drains the rectal fistula. The wound heals by filling in with scar tissue so the fistula does not come back or form an abscess. Your healthcare provider may also drain an abscess during your surgery.


Before your surgery:

Tell your healthcare provider if you have any other medical conditions, such as bleeding problems or cancer. Tell him if you had any anal or rectal surgeries in the past.

  • Bring your medicine bottles or a list of your medicines when you see your healthcare provider. Tell your provider if you are allergic to any medicine. Tell your provider if you use any herbs, food supplements, or over-the-counter medicine.
  • You may need to take an antibiotic medicine before your surgery. This medicine helps prevent an infection.
  • You may need certain lab or imaging tests before your surgery. Your healthcare provider may need to look inside your rectum with a scope to find your fistula. This scope is a long, bendable tube with a camera on the end. If this is painful, you may be given this exam during surgery when you are asleep. Ask your healthcare provider for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  • Write down the correct date, time, and location of your surgery.

The night before your surgery:

  • You may need to stop eating and drinking for several hours before your surgery. Ask your healthcare provider for more information on when you should do this.

The day of your surgery:

  • You or a close family member will be asked to sign a legal document called a consent form. It gives healthcare providers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  • Your bowel may need to be emptied and cleaned out before the surgery. Healthcare providers will give you a liquid medicine called an enema. This will be put into your rectum to help empty your bowel.
  • Healthcare providers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  • An anesthesiologist may talk to you before your surgery. This healthcare provider may give you medicine through your IV to make you sleepy before your surgery and to keep you asleep during your surgery. He may decide to give you medicine through an injection in your spine. This will make you numb from the waist down. Tell your healthcare provider if you or anyone in your family has had problems using anesthesia in the past.


What will happen:

  • You will be given anesthesia to make you fall asleep. You will be placed on your stomach or on your back with your feet in stirrups. Your healthcare provider will use his finger to guide a probe into your fistula. Your healthcare provider will insert a tool to hold the fistula open. This will help him move the probe with ease.
  • Your healthcare provider will use the probe as a guide to cut along the length of the fistula. Then, your healthcare provider will use a tool to scrape out any tissue buildup from your fistula. Your healthcare provider also may need to cut open and drain any abscesses during surgery. Your healthcare provider may also need to close the rectal opening to the fistula. The other fistula opening in the skin will be held open with stitches, heat, or other methods. Your healthcare provider may place small thread-like material in your wound to help fluid drain. He may also cover your wound with a bandage. It may take between 4 and 16 weeks for you to heal, depending on how complex your rectal fistulotomy is.

After your surgery:

You will be taken to a room where you can rest until you wake up. If you are staying in the hospital, you will be taken to your room. Do not get out of bed until your healthcare provider says it is okay. Your healthcare provider may give you the following medicines:

  • Pain medicine: Healthcare providers may give you medicine to take away or decrease your pain.
    • Do not wait until the pain is severe to ask for your medicine. Tell healthcare providers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling for help when you want to get out of bed.
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.


  • You cannot be at your surgery on time.
  • You have questions or concerns about your surgery.
  • You have a fever.
  • You get sick with a cold or the flu.
  • You have drainage or bleeding from your wound that does not stop.
  • Your rectal fistula becomes more painful than before.


  • A rectal fistula rarely heals without surgery. Infection from a rectal fistula may be life-threatening without surgery. You may have severe pain after your surgery. You may lose bowel movement or gas control if the sphincter in your anus is cut. A sphincter is a muscle that helps you control when you pass gas or bowel movements.
  • You may get a fever, skin infection, or have bleeding after surgery. It may be painful to pass a bowel movement, or you may be constipated as you recover from surgery. This is more common in elderly patients. Rarely, you may not be able to urinate as easily as before. You may also get a urinary tract infection. This is a bacterial infection that makes it painful to urinate. You may also have swelling or drainage in your wound area. Your rectal fistula may come back, even after surgery. You may need more than one surgery to help heal the fistula. You may have chronic (long-term) drainage. Your healing may be delayed if you have Crohn disease. Rarely, your fistula could cause cancer or sepsis if it is not treated. Sepsis is a dangerous blood infection caused by bacteria that can be life-threatening.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

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