- Technique
- Identify the Fistula Tract
- Locate external opening on the perianal skin
- Gently pass a probe through the tract toward the internal opening
- Use hydrogen peroxide or methylene blue to confirm internal opening if not obvious
- Lay Open the Tract
- Once the probe is in place, incise the overlying tissue along the tract using diathermy or scalpel
- Divide skin, subcutaneous tissue, and any involved sphincter muscle — only if limited to low fibres
- Avoid overcutting sphincter to preserve continence
- Curettage and Cleaning
- Curette the tract to remove granulation tissue and debris
- Irrigate the wound to ensure a clean base
- Wound Management
- Leave wound open to heal by secondary intention
- Apply haemostasis with diathermy or absorbable sutures as needed
- Some surgeons marsupialize the wound edges to prevent premature skin closure