A procedure in which the inflamed tunnel (fistula) that forms between the anus and the perianal skin is surgically cleaned out or closed.
Indication
- Persistent fistula developing after recurrent perianal abscesses
- Fistulas causing constant discharge, itching, and perianal pain
- Fistulas accompanying inflammatory bowel diseases such as Crohn's disease
- Complex fistulas that do not improve with antibiotics and drainage
- Intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric types according to the Parks classification
- Chronic perianal discharge affecting work and quality of life
Preparation
- In addition to clinical examination, the anatomy of the fistula is mapped with MR fistulography or endoanal ultrasound when needed
- If an active abscess is present, drainage is performed first; a seton thread is placed if needed
- Standard blood tests and ECG complete the preoperative evaluation
- Blood-thinning medications are adjusted with physician approval
- Fasting for 6-8 hours before the procedure and an enema if required
How it's performed
- The patient is placed in the lithotomy or prone position and spinal or general anesthesia is administered
- The external and internal openings of the fistula are identified and the channel is carefully evaluated
- For superficial fistulas involving little of the sphincter (anal muscles), fistulotomy (laying open the channel to heal as a wound) is performed
- For fistulas involving more sphincter muscle, a seton (drainage thread) may be placed to preserve function
- Among sphincter-preserving methods, options such as the LIFT procedure, advancement flap, laser closure of the fistula tract (FiLaC), or VAAFT may be used
- Staged treatment is planned for Crohn's-related and complex fistulas; the appropriate technique is selected according to the fistula's anatomy
Post-procedure
- Most patients are discharged the same day or after a 1-day hospital stay
- Warm sitz baths, local dressings, and stool softener therapy are arranged
- A high-fiber diet and ample fluid intake aid wound healing
- Complete healing of the wound may take 4-12 weeks depending on the technique
- Recurrence and wound healing are followed with regular check-up examinations
Risks
- Pain, bleeding, and surgical site infection at the wound
- Recurrence of the fistula (especially in complex fistulas)
- Anal stricture or delayed wound healing
- Temporary or permanent reduction in gas/stool control (especially in techniques involving sphincter intervention)
- Flare-ups and prolonged healing in Crohn's patients
FAQ
Can anal fistula be treated with medication?
Antibiotics may temporarily suppress inflammation, but lasting resolution is generally surgical; in Crohn's disease, additional medical therapy is also used.
Will I have gas or stool incontinence after surgery?
The technique is selected according to the fistula's anatomy to minimize this risk; sphincter-preserving techniques may be preferred in this regard.
Does the fistula recur?
The recurrence rate is low for simple fistulas; complex fistulas or those associated with Crohn's may require staged treatment.
How long does the recovery process take?
Although it varies by technique, complete wound healing usually takes 4-12 weeks; dressings and warm bath care are important during this period.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Anal fissure surgery
Surgical Outpatient Services
Anal fissure surgery — lateral internal sphincterotomy for the surgical treatment of chronic anal fissures.
Hemorrhoidectomy
Surgical Outpatient Services
Hemorrhoidectomy — surgical removal of enlarged hemorrhoidal tissue in advanced-stage hemorrhoidal disease.
Colorectal Surgery
Surgical Outpatient Services
Colorectal surgery — laparoscopic and open treatment options for diseases of the colon and rectum.
Thrombosed Hemorrhoid
Surgical Outpatient Services
Thrombectomy of a thrombosed hemorrhoid — a small surgical procedure that provides rapid relief by removing the clot from an acute, painful external hemorrhoid.
Pilonidal Sinus Surgery
Surgical Outpatient Services
Pilonidal sinus surgery — surgical treatment of the hair-containing tunnel in the natal cleft.
Inflammatory Bowel Disease Treatment
Internal Medicine Outpatient Services
IBD treatment — individualized therapy for flare-up control and long-term remission in Crohn's disease and ulcerative colitis.
Abscess Drainage
Surgical Outpatient Services
Abscess drainage — surgical evacuation of inflammatory collections in the skin and soft tissue.
Inguinal Hernia Repair
Surgical Outpatient Services
Inguinal hernia repair — surgical repair of a groin hernia using mesh or tissue technique.