A Anal fistulotomy and fistulectomy
Most perianal fistulas arise as a result of infection within the anal glands located at the dentate line (cryptoglandular fistula). Fistulas may also arise as the result of trauma, Crohn’s disease, inflammatory processes within the peritoneal cavity, neoplasms, or radiation therapy. The ultimate treatment is determined by the cause and the anatomic course of the fistula and can include fistulotomy and fistulectomy. The primary goal is palliation, specifically to drain abscesses and prevent their recurrence. This is often accomplished by placing a Silastic seton (a ligature placed around the sphincter muscles) around the fistula tract and leaving it in place indefinitely. In the absence of active Crohn’s disease in the rectum, attempts at fistula cure may be undertaken.