Anal fistula Surgery

An anal fistula is a tract that connects the inside of the anal canal to the skin adjacent to the anus. Fistulas can cause discharge, pain, itching and lead to recurrent abscess formation; they therefore need treatment.

Simply opening the tract and allowing the area to heal up can treat most fistulas. However, when fistulas run in a course that involves a significant portion of the anal sphincter muscle this is not possible due to the risk of incontinence; in this case a more complex approach is necessary.

Options for more complex fistulas include:

1. Advancement flap. Part of the rectal wall above the fistula is mobilized and sutured over the hole.
2. Fistula plug. Another option is to use the relatively recently introduced anal fistula plug. There are a number of designs of fistula plug, but all essentially do the same thing. The plug is made of collagen and is inserted into the tract and secured in position. This is usually done with the patient under a general anaesthetic. Tissue surrounding the plug grows into the collagen, thereby closing the defect permanently. The advantages of the anal fistula plug procedure over more invasive operations include less pain and no risk of damaging the anal sphincter muscles. However, as with all operations, there are a number of risks, which include infection in the short term and non-healing of the tract in the longer term. Your surgeon will be able to discuss with you these risks, as well as any alternatives. Our surgeons have experience in anal fistula plug procedures.
3. LIFT procedure. The fistula tract is dissected out and tied off near the internal opening.
4. Seton insertion. Fistulas can be managed by passing a suture or piece of rubber tubing through the tract to facilitate drainage of any infection. Setons can be either used on a short term basis, prior to another operation to attempt to eliminate the fistula, or as a long-term measure.

We will be able to advise you on the most suitable treatment if you have a fistula.