What is the evidence that simple fistulotomy reduces recurrence rates compared with other sphincter-preserving techniques in patients with CD

What is known

- In selected low fistulae without sphincter involvement, proctitis, or anal-canal disease, simple fistulotomy achieves 80–100% healing; active proctocolitis drops this to ~27%. ¹ - Sphincter-preserving techniques (advancement flap ~50–64% healing, LIFT, glue, plug) are poorly studied in crohn's and may fare worse than in cryptoglandular disease; no direct comparative recurrence data is offered. ^2–4 - Fistulotomy carries incontinence risk that rises with sphincter involvement (>50% incontinence when >one-third of sphincter is divided), so patient selection — not a recurrence advantage — drives its use. ¹

What is unknown / caveats

- No retrieved study directly compares fistulotomy vs sphincter-preserving techniques for recurrence in crohn's - Healing/recurrence figures come from selected series and surveys with heterogeneous outcomes and short follow-up - The evidence characterizes fistulotomy and sphincter-preserving options separately but does not isolate a comparative recurrence endpoint.

## References

1. Lee JJ, Lightner AL. Management and Treatment of Perianal Fistulizing Crohn's Disease. Clin Exp Gastroenterol. 2025;18:291-303. PMID: 41415490.

2. Tozer P, Borowski DW, Gupta A, Yassin N, Phillips R, Hart A. Managing perianal Crohn's fistula in the anti-TNFα era. Tech Coloproctol. 2015;19(11):673-8. PMID: 26264168.

3. Sica GS, Di Carlo S, Tema G, Montagnese F, Del Vecchio Blanco G, Fiaschetti V, Maggi G, Biancone L. Treatment of peri-anal fistula in Crohn's disease. World J Gastroenterol. 2014;20(37):13205-10. PMID: 25309057.

4. Yassin NA, Askari A, Warusavitarne J, Faiz OD, Athanasiou T, Phillips RK, Hart AL. Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn's disease. Aliment Pharmacol Ther. 2014;40(7):741-9. PMID: 25115149.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._