Group (II) underwent Fistulotomy and primary sphincteroplasty
fistula, incontinence, pain
WOUND INFECTION, RECURRENCE, INCONTINENCE, COMPLICATIONS
The patient was operated in lithotomy position under spinal anesthesia. The internal opening of the fistula within the anal lumen was visualized using a probe introduced through the external opening as in Fig. 
Visualization of the internal opening of the fistula using a probe from the external opening
Shows stay sutures through the edges of the sphincter
Shows the dissection of the sphincter until the dorsal aspect of the fistula
Shows sphincter reconstruction using PDS 3 − 0 transverse mattress suturesPost-operative work-up and follow-up for one-year duration. Post-operative complications in the form of: wound infection, post-operative pain, early incontinence and recurrence. Patients received oral antibiotics for one week postoperatively. Intake of liquid food was resumed in the evening after the operation they were advised to have a soft diet for 2 days and bulk laxatives for at least 2 weeks. Dressing of the wound was done on the second day postoperatively for all patients. All patients were trained on how to clean themselves and how to do the wound dressing. All Patients were followed up after one week, 2 weeks from discharge then every two weeks until complete healing. Then every two months to complete a one-year follow-up. The fistula was defined to be healed when the external wound healing completed with no discharge. Persistent or recurrent external opening after 2 months of the procedure was considered as recurrence. Patients were observed for the recurrence of the fistula during the follow-up period. None of our patients were lost during the follow-up period.The initial design of the study included a more follow up time (24 months) but unfortunately, we lost the contact with 6 patients after 12 months follow-up and another 8 patients after 18 months, so we were compelled to reduce our follow-up period to be 12 months.