- Make curvilinear incision in the intersphincteric groove overlying the fistula
- Dissect through the intersphincteric plane to identify the fistula tract
- Use meticulous sharp dissection to avoid sphincter injury
- Mobilise, encircle and ligate the fistula tract close to the internal sphincter
- Ligate with absorbable suture and divide the tract
- Curette or irrigate the remaining distal tract
- External opening is often left open for drainage
- Close intersphincteric wound in layers +/- Anocutaneous flap