A fistulotomy is the most effective treatment for many anal fistulas, although it’s usually only suitable for fistulas that do not pass through much of the sphincter muscles, as the risk of incontinence is lowest in these cases.
If the surgeon has to cut a small portion of anal sphincter muscle during the procedure, they’ll make every attempt to reduce the risk of incontinence.
In cases where the risk of incontinence is considered too high, another procedure may be recommended instead.
Fistulectomy with Sphincter Repair: Fistulectomy with sphincteroplasty or Sphincter repair and partial closure of the residual cavity, as described, is a safe procedure but has to be performed by dedicated colorectal surgeons. It is a procedure performed wherein if there is a high Anal fistula or a complex fistula that involves sphincter complex muscles and routine surgery would damage the muscles thus causing incontinence to stool. This is one of the most complex procedures done which is also helpful in the recurrent anal fistula.