Anal Fistula Surgery

Anal fistula repair surgery includes several procedures that treat anal fistulas. An anal fistula is an abnormal tunnel that forms between the inside of your butthole (anus) and the skin around it. Many fistulas happen after an infection or a pocket of pus (abscess) develops near your anus.

Fistula surgery is usually the main treatment. Surgeons often do these procedures in several steps. In some cases, you may only need one surgery. But you may need several surgeries over many years to get to a solution.

The goals of surgery are to:

• Drain infection
• Protect the two muscles around your anus that control bowel movements (anal sphincter muscles)
• Close the fistula
• Prevent the fistula from coming back

What happens during fistula repair surgery?

On the day of the procedure, you’ll get anesthesia so you won’t feel any pain. Make sure you have someone to drive you home.

The steps of surgery depend on the type of procedure you need.

Fistula exam

First, your surgeon will do a detailed exam of the fistula. While you’re asleep, they can get a better look at the fistula without causing you discomfort. They’re looking for three things during this exam:

• If there’s any infection
• If your anal sphincter muscles are involved
• How much of each muscle is involved

From there, your surgeon will decide which type of surgery to use.

Surgery types

There are usually two options at this point:

• Fistulotomy: If there isn’t a lot of muscle involved, your surgeon can do a fistulotomy. During this procedure, your surgeon will unroof the tunnel so it’s wide open. Fistulotomy surgery usually has a high success rate. You likely won’t need any additional treatment.
• Seton placement: If there’s too much muscle involved, your surgeon will place a seton drain. A seton is a thin, flexible plastic loop loosely placed through the tunnel. This helps keep it open so the infection can drain. After surgery, your surgeon will wait for the swelling to go down. This can take two to three months. Then, they’ll re-examine the fistula and decide which additional procedure to use to fix it.

Procedures after seton placement

After the infection drains and the swelling goes down, your surgeon can use several types of surgery to fix the anal fistula:

• Fistulotomy: If the muscle is thin after the swelling goes down, your surgeon can perform a fistulotomy.
• Endorectal advancement flap procedure: In this surgery, your surgeon will create a flap in the lining of your rectum. It’s usually very stretchy, and they’ll pull it over the inside opening of the fistula. Then, they’ll sew it over the opening.
• LIFT procedure (ligation of intersphincteric fistula tract): During this procedure, your surgeon will separate the two muscles around your anus and find the tunnel traveling through them. Then, they’ll cut the tunnel, sew the openings closed and put the muscles back together.
• Fibrin glue or fistula plug procedures: These procedures involve sealing or filling the fistula with special materials. Surgeons rarely use these procedures because they have high failure rates.
• Minimally invasive procedures: These procedures involve laser closure of the tunnel. They don’t have well-established success rates.

Surgery may take anywhere from five minutes to two hours. It depends on the procedure and how complex the fistula is. Many fistula surgeries are outpatient procedures. That means you can go home the same day.

Fistula repair surgery recovery

Recovery depends on the type of surgery you have. Some people recover within a few weeks. Others may need several months to fully heal.

After surgery, you may have:

• Mild bleeding or drainage
• Pain or soreness
• Swelling
• Fatigue

Your surgeon will give you specific instructions to use during your recovery.

Possible complications

Post-operative complications and risks can vary. It depends on the type of surgery and how complex the fistula was. One of the main risks is the chance of the fistula coming back. This usually shows up as an infection in the area. You may have drainage, or the area could be hot and painful.

Other possible complications and risks include:

• Heavy, ongoing bleeding
• Delayed healing
• Problems controlling gas
• Trouble holding in your poop

When can I return to normal activities?

After surgery, your activity will depend on which procedure your surgeon did. They’ll provide you with specific activity instructions.

When should I call my healthcare provider?

Call your provider if you have:

• Fever or chills
• Worsening pain
• Heavy bleeding
• Swelling, redness or skin discoloration
• Foul-smelling drainage
• Constipation that doesn’t improve
• New drainage or signs the fistula may have returned