## **Core Concept**
The treatment of anal fistulas, also known as fistulae-in-ano, depends on their classification, which often includes the Parks classification or the St. James's Hospital classification. A low fistula in ano typically involves the lower part of the anal sphincter and is closer to the anal verge.

## **Why the Correct Answer is Right**
The correct answer, **Fistulotomy**, is the treatment of choice for low fistulas in ano. This procedure involves surgically opening up the fistula tract to allow it to heal from the bottom up. For low fistulas, fistulotomy is preferred because it has a high success rate of healing and a lower risk of incontinence compared to other procedures. This method works well for low fistulas as they usually do not involve a significant portion of the anal sphincter, minimizing the risk of postoperative incontinence.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, other treatments like fistulectomy (removal of the fistula tract) or more complex procedures like Ligation of the Intersphincteric Fistula Tract (LIFT) might be considered for different types of fistulas. However, for low fistulas, these are not the first line.
- **Option B:** This option is also not provided, but procedures like seton placement (insertion of a drainage tube) are usually reserved for high or complex fistulas where fistulotomy could lead to significant incontinence.
- **Option C:** Similarly, not provided, but treatments like colostomy might be considered in very complex cases or as a temporary measure to divert fecal stream, not as a primary treatment for low fistulas.
- **Option D:** Not specified, but assuming it's another surgical option, the reason it's incorrect would depend on its specifics, but generally, for low fistulas, simpler and more direct approaches like fistulotomy are preferred.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the management of fistula-in-ano aims to balance the need for eradication of the fistula with the preservation of continence. For low fistulas, **fistulotomy** is often the straightforward and effective approach. Always consider the risk of incontinence and the complexity of the fistula when choosing a treatment.

## **Correct Answer:** . Fistulotomy