Modified fistulotomy with internal orifice distalization for optimized perianal fistula management: Pressure zone transition

Figure 2 Key steps of the modified fistulotomy technique. A: Distalization of the internal orifice achieved by incising the anoderm and partially cutting the internal sphincter up to the intersphincteric groove; B: Excision of the fistula tract up to the external sphincter muscle; C: Curettage of the remaining fistula tract; D: Distalization of the internal opening; E: Internal and external openings without signs of inflammation at postoperative month 3.