Fistulotomy for superficial or minimal sphincter-involving fistulae in perianal Crohn’s disease: do they heal?

Abstract Background Fistulotomy is highly effective (> 90%) for cryptoglandular fistula-on-ano, but fistulotomy in perianal Crohn’s disease (pCD) is limited due to increased risk of recurrent fistulae, diarrhea, and fecal incontinence. We hypothesized that superficial fistulotomy resulted in wound healing in most patients. Method We conducted a single-center retrospective review of adult patients with pCD who underwent fistulotomy from 1999 to 2022. Baseline characteristics, pCD characteristics, and short- and long-term surgical and functional outcomes were reported. Matched-pair Wilcoxon signed-rank test was used to compare continuous data. Results A total of 43 adult patients with pCD underwent fistulotomy and were included: 29 (67.4%) were male, with an age of 34 (28–42) years and a follow-up time of 4.3 years. Prior interventions included draining setons (48.8%) and partial fistulotomy (17.4%); 25.6% had no prior surgery. Fistulotomies were subcutaneous (65.1%), low transsphincteric (16.3%), intersphincteric (4.7%), and unspecified (14%). Short-term complications included pain (20.9%), bleeding (4.7%), and seepage (2.3% each), and 58.1% of the patients had no complications. Long-term complications included bleeding, keyhole deformity, nonhealing wounds, and anal stricture (2.3% each), and 60.5% did not experience long-term complications. At the last follow-up, 41 (95.3%) patients had complete healing of the fistulotomy site. Conclusions Fistulotomy was safe in select patients with fistulizing pCD and superficial fistulas with little or no sphincter involvement. We observed that fistulotomy was associated with wound healing, decreased drainage, and social restrictions in most patients, suggesting that this is a viable and safe option for this at-risk group.