Fistulectomy versus Fistulotomy in the Treatment of Anal Fistula: A Comparative Analysis

Abstract

Background: Anal fistula is a very common anorectal condition, and our management has become difficult from a surgical perspective because of the potential for the condition to recur and cause damage to the sphincter. Among the common operations performed at the gastrointestinal level, fistulotomy and fistulectomy each have their advantages and disadvantages.

Objective: To compare the clinical results, immediate recovery, and recurrence in those having an anal low-lying simple fistula with fistulectomy and fistulotomy.

Methods: The study was a comparative prospective study that took place at Ayub Teaching Hospital Abbottabad, from July 2025 to December 2025. Eighty patients with primary low or simple anal fistulas were enrolled and assigned to either fistulotomy (n=40) or fistulectomy (n=40).

Results: Fistulotomy was associated with significantly lower postoperative pain in patients and quicker wound healing (mean 21.5 ± 4.3 days) than fistulectomy (mean 32.8 ± 5.6 days; p < 0.001). Fistulectomy patients had minor transient incontinence in 5%, whereas no incontinence occurred in animals not undergoing fistulectomy.

Conclusion: Fistulectomy is reserved for cases where recurrence prevention is desired, and for simple low anal fistulas, fistulotomy proved to be a preferred option for faster recovery and to conserve anal continence with low postoperative pain level.