Comparison of a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula: a randomized, controlled pilot trial.
pISSN 2093-7822 eISSN 2093-7830
Journal of the Korean Society of
Comparison of a Fistulectomy and a Fistulotomy with
Marsupialization in the Management of a Simple Anal Fistula:
A Randomized, Controlled Pilot Trial
Do Sun Kim
Department of Surgery, Daehang Hospital, Seoul, Korea
J Korean Soc Coloproctol 2012;28(2):67-68
Therefore, the fistulotomy is regarded as the standard treatment
for simple anal fistulae and is the most widely-performed proce-
dure. 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 fistulec-
tomy group . The fistulectomy has a potential advantage over
the fistulotomy only when the fistula tract has not been explored
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 heal-
ing [2, 3]. However, this added procedure cannot prevent postop-
erative 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 divi-
sion, a fistulotomy with or without marsupialization is considered
to be a very effective and safe procedure. Particularly in low, sim-
ple-type fistulae, the fistulotomy is the most widely-performed
1. Belmonte Montes C, Ruiz Galindo GH, Montes Villalobos JL,
Decanini Teran C. Fistulotomy vs fistulectomy. Ultrasonographic
evaluation of lesion of the anal sphincter function. Rev Gastroen-
terol Mex 1999;64:167-70.
2. Pescatori M, Ayabaca SM, Cafaro D, Iannello A, Magrini S. Mar-
supialization of fistulotomy and fistulectomy wounds improves
The ultimate purpose of surgical treatment for an anal fistula is
the eradication of sepsis while maintaining continence. To achieve
these goals, it is essential to identify the internal opening, as well
as the relationship between the fistula tract and the sphincters,
before or at the time of surgery. When the internal opening is not
identified or is misdiagnosed, recurrence and unnecessary sphinc-
ter injury may be the result. Accurate diagnosis of the type of fis-
tula is also important to determine an appropriate surgical treat-
ment. A simple way of differentiating a simple fistula from a com-
plex fistula is palpation of the tract. If the tract is palpable from
the external opening to the anal verge, it is safe to regard the fis-
tula as a simple type.
Various surgical treatments, including a fistulotomy, a fistulec-
tomy, a seton and more complex sphincter-preserving procedures,
are currently used depending on the type of fistula and the patient’s
continence. Recently, newer sphincter-preserving treatments, such
as fibrin glue injection and fistula plug insertions, have been in-
troduced. However, the postoperative healing rates are unpredict-
able and sometimes below our expectation. In the case of the liga-
tion of intersphincteric fistula track (LIFT), the procedure is sim-
ple and shows results comparable to those of advancement flaps.
No studies have been done comparing LIFT with other conven-
tional treatments, and some questions as to whether it is as effec-
tive and technically feasible for complicated-course suprasphinc-
teric fistulae or fistulae remain.
Correspondence to: Do Sun Kim
Department of Surgery, Daehang Hospital, 481-10 Bangbae 3-dong,
Seocho-gu, Seoul 137-820, Korea
Tel: +82-2-6388-8114, Fax: +82-2-6388-8115
© 2012 The Korean Society of Coloproctology
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See Article on Page 78-82
Journal of The Korean Society of
Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of
a Simple Anal Fistula: A Randomized, Controlled Pilot Trial
Do Sun Kim
healing and decreases bleeding: a randomized controlled trial.
Colorectal Dis 2006;8:11-4.
3. Ho YH, Tan M, Leong AF, Seow-Choen F. Marsupialization of
fistulotomy wounds improves healing: a randomized controlled
trial. Br J Surg 1998;85:105-7.