Which treatment is never performed simultaneously with abscess drainage in high anal fistulae?

When managing high anal fistulae, the treatment typically chosen for simultaneous intervention with abscess drainage is considered based on the complexity of the fistula and associated factors like the degree of sphincter involvement.

Fistulotomy, which is a procedure that involves cutting along the entire length of the fistula tract to allow it to heal from the inside out, is generally not performed simultaneously with abscess drainage for high anal fistulae. The reason lies primarily in the high risk of incontinence and the need for careful evaluation and planning regarding the treatment of high fistulae, especially when they involve a significant portion of the anal sphincter musculature.

In contrast, other procedures such as anal fistula plugs, seton placement, and anorectal advancement flaps may be performed either as separate stages or in conjunction with abscess drainage. These techniques are often more conservative and can accommodate the presence of an abscess, which is crucial in managing the underlying pathology without compromising anal function.

Thus, the distinction of fistulotomy being avoided when simultaneously addressing an abscess reflects a keen understanding of sphincter preservation and the complexities surrounding high anal fistula surgeries.