Hello, I Have Had Anal Fissures All My Life, Occurring

Hello,

I have had anal fissures all my life, occurring and healing and reoccurring when I have a hard stool due to poor diet/water. They have always healed. Now I have a fistula after an abscess that I believe started with one of the fissures becoming infected.

I have 2 semi-large sentinel piles that sometimes become inflamed, typically during fissure occurrence. They always heal and become painless again as well and I go several months without issue before passing a hard stool and recurrence. I need to have a fistulotmy for the fistula, but my question is do I also have to have surgery on the fissures (I believe I have more than one)?

I am wondering if now that I have recognized my problem (I only started paying attention and realizing my lifelong problem when discovering the most recent fistula) and if I make a lifestyle change of drinking enough water, taking in fiber and using stool softeners as needed going forward, is it possible to only have a fistulotomy and leave the fissures and sentinel piles alone? Would this lead to any problems?

Thank you