Treatment options for anal fistula (surgical and non-surgical)

Anal fistula, also known as anal fistula, is the formation of a small tube between the end of the large intestine and the skin around the anus. The fistula hole can be seen from the surface of the skin and from this hole pus or feces can come out during a bowel movement.

Most fistulas are the result of an infection in the anal gland that causes a small lump of pus (abscess). This abscess then swells and makes it difficult for the abscess to get out of the anal gland. The result is inflammation that extends to the perineum (area of skin around the anus), anus, or the whole, and then becomes a fistula.

This condition is usually treated with surgical procedures. There are several surgery options available to you.

Medication to treat fistula in ani

The choice of surgery depends on the position of the fistula, the depth and breadth of the fistula duct, and whether it is a single duct or branches in different directions.

The surgeon will provide the best surgical options for you. Anal fistula surgery is generally performed on an outpatient basis. However, if the fistula is very large or deep, you may need to stay several days in the hospital.

Surgery is performed to heal the fistula and avoid damage to the sphincter muscles, the ring of muscle that opens and closes the anus, which can potentially result in loss of colon control.

Surgical options for treating anal fistulas

1. Fistulotomy

A fistulotomy is the most common type of surgery to treat fistulas in ani. This operation is usually performed under general anesthesia and then opens the fistula tube through an opening in the anal canal to the outer opening and creates a groove that will heal from the inside out.

Fistulotomy is an effective treatment for most cases of fistula ani. Although this procedure is usually only suitable for fistulas that do not pass through much of the sphincter muscle, it reduces the risk of urinary incontinence.

Fistulotomy is a long-term treatment with a high success rate, around 92-97%. However, if the risk of incontinence is high, doctors will usually provide other surgery options.

2. Seton technique

If your fistula passes through most of the anal sphincter muscle, your doctor may offer to insert a seton.

A seton is a surgical thread that is left in the fistula for several weeks to keep it open. This is useful for drying the fistula, helping it heal, and preventing unnecessary cutting of the sphincter muscles.

Loose seton allows the fistula to flow, but does not heal it. To heal the fistula, a tighter seton can be used to slowly cut the fistula.

3. Advanced flap procedure

A follow-up flap procedure may be performed if the fistula passes through the anal sphincter muscle and undergoes a fistulotomy which is at high risk of causing incontinence. This procedure is performed by cutting the fistula and covering the point of origin of the fistula with healthy tissue.

This procedure has a lower success rate than fistulotomy, but it avoids cutting the sphincter muscles. Anal fistulas may reappear after this procedure.

People with certain conditions such as Crohn's disease, have had tissue irradiated, have had previous treatment, and smoking increases the likelihood of failure. In addition, even if the sphincter muscles are not cut in this procedure, mild to moderate incontinence can still occur.

4. Bioprosthetic plug

Another option in cases where a fistulotomy is a risky cause of incontinence is the insertion of a bioprosthetic plug. This is a cone-shaped plug made of animal tissue that is used to block the internal opening of the fistula.

This procedure also does not require cutting of the sphincter muscles. However, this procedure has a relatively low success rate, around less than 50%.

5. The LIFT procedure

Ligation of the intersphincteric fistula tract (LIFT) is a relatively new procedure for treating fistula ani.

This procedure is designed as a treatment for fistulas that pass through the anal sphincter muscle, where performing a fistulotomy would be too risky.

During treatment, a cut is made in the skin over the fistula and the sphincter muscles separate. The fistula is then sealed at both ends and cut open so that it lies flat.

So far, this procedure has had some promising results, but more research is needed to determine how well it works in the short and long term.

Treatment for anal fistula without surgery

Fibrin glue is the only non-surgical treatment option for anal fistulas, to date.

This procedure is performed by a surgeon by injecting special glue into the fistula after you have been sedated. This glue will help seal the fistula.

Compared to fistulotomy, this procedure is less effective for fistulas and the results are not long-lasting. However, fibrin glue may be the right choice for fistulas that pass through the anal sphincter muscles because they don't need to be cut.

For clearer information about which procedure is most suitable for you, please consult directly with your doctor. The reason is, everyone's condition is different.