Greenview Medical Center

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Fistula – Fistulectomy

What is it?

A fistula is an abnormal, tube-like connection, a hole that forms between the two organs or an organ in the body and skin. They develop anywhere between an intestine and the skin, between the vagina and the rectum, and other places.

Fistulectomy is a surgical procedure where a fistulous tract is cut out completely.

Fistulas can also form in the digestive tract or perianal region after surgery, radiation therapy for cancer, or a traumatic injury. Some diseases and infections can also cause fistulas, such as diverticulitis, sexually transmitted disease, and tuberculosis.


The different types of Fistula that are commonly found are:

  • Urinary Tract Fistulas: an abnormal connection between a urinary tract organ and another organ.
  • Anal Fistulas: an abnormal connection between the epithelialized surface of the anal canal and the perianal skin.
  • Enteroenteric or Enterocolic: a fistula that involves the large or small intestine.
  • Enterocutaneous: fistula from the intestine to the skin.


Some of the common symptoms found in patients suffering from Fistula are:

  • Constant urine leakage
  • Irritation in the external female genital organs
  • Frequent urinary tract infections
  • Leakage of gas
  • Feces into the vagina
  • Fluid drainage from the vagina
  • Nausea
  • Diarrhea
  • Abdominal pain


Fistulas can be diagnosed through the use of

  • A physical examination,
  • A computed tomography (ct) scan,

And, if needed, through other tests like,

  • Barium enema,
  • Colonoscopy,
  • Sigmoidoscopy,
  • Upper endoscopy,
  • Fistulogram.


Depending on the severity of the condition, the surgeon will inject a contrast dye into the fistula’s external opening and an imaging tool, such as an X-ray or MRI, to see all the parts of the fistula clearly.

The surgeon will then proceed to remove all the three parts of the fistula. Under spinal anesthesia, the patient will be positioned in the lithotomy position, which is keeping the patient’s legs higher or at the same level as the hips. Then the inspection and identification of the site of the external opening are performed.

Hydrogen peroxide is then injected in the external opening to identify the presence and site of internal opening. A probe is passed into the external opening to define the direction of the fistula tract to the internal opening and to classify the fistula according to Park’s classification.

Once the track had been cored out from the external toward the internal opening, either with scissors or with cautery dissection, simple anatomical closure of the cored-out tunnel with mucosal closure of the defect with interrupted absorbable sutures is performed. The wound outside the sphincters will then be lightly packed.

As the fistulectomy completely removes the fistula tract, the recovery can take a considerable amount of time and increase the risk of complications. Recovery from a fistulectomy can take anywhere from 4 to 6 weeks.


In rare cases, some patients might experience the following risks:

  • Severe scarring
  • Distortion
  • Recurrence
  • Incontinence

To help minimize the risks, patients are prescribed with antibiotics and given strict post-surgical care instructions following the procedure. The surgeon will also schedule a number of post-operative checkups to observe the patient’s recovery.