A Fistulotomy is the procedure used to surgically treat an anal fistula. Most fistulotomies can be performed on an outpatient basis in our Surgery Center. Usually the procedure involves cutting a small portion of the anal sphincter muscle to open the passage, joining the external and internal opening, and converting the passage into the groove that will then heal from the inside out. Sometimes a more complicated procedure is necessary if too much sphincter muscle is involved. If the fistula involves too much sphincter muscle, a more complicated, “two-stage” procedure may be necessary. This includes an endorectal advancement flap, the LIFT procedure (ligation of intersphincteric fistula tract), or a fistula plug.