What is an anal fistula?
An anal fistula is a pathological tract (tunnel) that connects the inside of the anal canal or the final part of the intestine with the skin around the anus. Through this tract pus, serous fluid or discharge occasionally leaks, and on the skin around the anus there are one or more openings from which it drains. A fistula is a chronic condition that, once formed, does not heal on its own and requires surgical treatment.
A fistula most often arises as a consequence of an earlier perianal abscess — a purulent collection around the anus. When the abscess bursts or is drained, a tract often remains that connects the source of the infection (most often a blocked anal gland) with the surface of the skin. That tract then becomes a permanent path through which the infection recurs, so repeated pus, pain and discomfort appear.
Symptoms of an anal fistula include constant or occasional leakage of pus and discharge around the anus, pain and swelling (especially when the tract becomes blocked and an abscess re-forms), itching, skin irritation and an unpleasant odor. The symptoms often alternate — a period of apparent calm followed by new pus — which is typical of a fistula that keeps recurring.
At Medical Time we carefully assess the anal fistula before the procedure, because its course, length and relationship to the muscles for stool control determine the choice of operation. The goal is to permanently remove or close the tract while preserving the function of the sphincter — the muscle key to stool control.
When is fistula surgery indicated?
An anal fistula almost always requires surgery, because it cannot be cured permanently with conservative measures — the tract remains and the infection recurs. The decision on the type of procedure is made by the surgeon after an examination and assessment of the course of the fistula, if needed with additional imaging.
Anal fistula surgery is recommended in the following situations:
- constant or occasional leakage of pus and discharge around the anus
- repeated perianal abscesses (purulent collections that keep returning)
- pain, swelling and tenderness in the area around the anus
- itching, irritation and moisture of the skin around the anal opening
- a fistula that does not settle and keeps recurring
- the existence of one or more openings on the skin from which discharge leaks
- the need for a lasting solution instead of the constant recurrence of pus
How fistula surgery is performed
The choice of operation depends above all on how much the fistulous tract involves the sphincter muscle — because it is exactly this muscle that allows stool control and must be protected. That is why before the procedure the surgeon carefully assesses the course of the fistula, and additional imaging is sometimes used for accurate mapping of the tract.
With superficial fistulas, which involve a small part of the muscle or none at all, a fistulotomy is most often done — the tract is opened along its whole length and left to heal gradually, from the inside toward the surface. This technique has a very high percentage of cure and is applied when the muscle for stool control can be safely preserved.
With fistulas that pass through a larger part of the sphincter, techniques that especially protect continence are applied: placement of a seton (a special thread that is passed through the tract and gradually drains and manages it), an advancement flap of the mucosa to close the internal opening, the LIFT technique (ligation of the tract in the space between the muscles) or other modern methods. With more complex fistulas, treatment sometimes proceeds in several steps.
The common goal of all these techniques is the same — to permanently remove or close the fistulous tract and the source of the infection, while at the same time preserving the function of the muscle for stool control. That is why an individual assessment and the surgeon's experience are decisive for a good outcome.
Preparation for fistula surgery
Preparation begins with a detailed examination by the surgeon, who assesses the course of the fistula and its relationship to the sphincter muscles. With more complex fistulas additional imaging is recommended (for example ultrasound or magnetic resonance) for accurate mapping of the tract. Since the procedure is done under anesthesia, preoperative preparation is also carried out.
Before the procedure, preparation of the final part of the intestine is usually done according to the instructions, so the area is clean. The anesthesiologist assesses the form of anesthesia (most often spinal or general), the rules on fasting apply and accompaniment for the return home is arranged.
What is important to inform the surgeon of before the procedure:
- all medications you take, especially blood thinners
- chronic illnesses (including inflammatory bowel diseases) and allergies
- earlier abscesses, fistula operations or other interventions in that area
- all symptoms related to stool control, if you have them
- bring earlier findings and imaging for review
- the rules on bowel preparation, fasting and arranged accompaniment
The procedure, anesthesia and duration
Fistula surgery is most often performed under spinal or general anesthesia, so the patient feels no pain during the procedure. The form of anesthesia is decided jointly by the surgeon and the anesthesiologist. The whole course takes place in the sterile conditions of the operating room, under anesthesiologist supervision.
After the anesthesia is introduced, the surgeon first precisely determines the course of the fistula (the internal and external openings and the direction of the tract), and then applies the planned technique — opening the tract (fistulotomy), placement of a seton, an advancement flap, LIFT or another method, depending on the relationship of the fistula to the muscle. The wound is, according to the technique, left to heal gradually or partly closed.
The duration depends on the complexity of the fistula: simple fistulas are resolved in 20 to 40 minutes, while more complex, multi-tract fistulas require more time. Throughout the procedure the anesthesiologist monitors the vital functions, so the procedure is safe and controlled.
After the procedure the patient recovers under the supervision of the staff. With simpler fistulas a return home the same day is possible, while more complex procedures sometimes require a short stay for dressing changes and monitoring, which the surgeon decides.
Recovery after fistula surgery
Recovery depends on the type of operation and on whether the wound heals gradually (which is often the case with a fistulotomy). In the first days mild pain, tenderness and minor discharge from the wound are normal. Tidy care of the area and a soft stool are key to a good outcome and easy healing.
The wound is kept clean, and lukewarm sitz baths help keep the area clean and calm it. When the wound heals gradually, dressing changes are done according to the instructions, sometimes over several weeks, until the tract closes from the inside toward the surface. A diet rich in fiber and enough fluids are recommended, so that emptying is not straining.
What is recommended during recovery:
- apply lukewarm sitz baths to keep the area clean and calm
- take in enough fiber and fluids so that the stool is soft
- change the dressing regularly and exactly according to the surgeon's instructions
- avoid long sitting, straining on emptying and strenuous activities in the first days
- come to the agreed follow-ups for monitoring of the healing
- contact the doctor if severe pain, increased pus, swelling, bleeding or a temperature appear
Risks and possible complications
Fistula surgery is a safe and standard procedure, but it carries a specific challenge — the tract must be removed while at the same time preserving the muscle for stool control. That is why the choice of technique and the surgeon's experience are decisive. The patient is informed in detail about the possible risks before the procedure.
Bleeding, wound infection, slower healing and, in some patients, recurrence of the fistula are possible — especially with complex, multi-tract fistulas, where treatment sometimes proceeds in several steps. The most serious risk is the effect on stool control, which is why for fistulas that pass through a larger part of the muscle techniques that especially protect continence are chosen.
It is important to understand that with complex fistulas a more gradual approach is sometimes deliberately chosen (for example a seton in several steps), precisely to avoid damaging the muscle and preserve stool control. With a proper assessment, the choice of an appropriate technique and careful monitoring of recovery, most risks are reduced to the lowest level. That is why it is important that a fistula is resolved by an experienced surgeon, in a facility that provides safe, hospital conditions.
Why have fistula surgery done at Medical Time
At Medical Time we resolve the anal fistula expertly and with full attention to preserving the function of the muscle for stool control. An experienced surgical team, modern techniques and a careful preoperative assessment allow the choice of an approach that gives the best outcome with the lowest risk, according to the complexity of the fistula.
We attach special importance to an accurate assessment of the course of the fistula before the procedure and to consistent monitoring of recovery, because a lasting cure depends precisely on that. After the procedure we stay with you for dressing changes, follow-ups and all advice on care, until the wound has fully healed.
- an experienced surgical team and modern techniques for treating fistulas
- a special approach to preserving continence (stool control)
- an accurate assessment of the course of the fistula before the procedure, if needed with imaging
- a painless procedure under spinal or general anesthesia
- modern, sterile hospital conditions and high safety standards
- carefully guided wound care and regular follow-ups until full healing
- a discreet approach, quick booking and support throughout recovery
Price
The price of anal fistula surgery depends on the complexity of the fistula (simple or multi-tract), the technique applied (fistulotomy, seton, LIFT, flap) and the form of anesthesia. The final price is determined after an examination and assessment; look at the surgical services in the price list, and you receive a precise estimate and an appointment by calling.
- Surgeon's examination and assessment of the course of the fistula
- Surgery of a simple fistula (fistulotomy)
- Surgery of a complex fistula (seton, LIFT, flap)
For an estimate and an appointment, call 062-399-888.
Frequently asked questions about fistula surgery
No. A fistula is a chronic tract that, once formed, does not close on its own and keeps recurring. Conservative measures can temporarily calm the pus, but a lasting cure is achieved exclusively by surgery.
During the procedure you feel no pain, because it is done under spinal or general anesthesia. After the procedure mild pain and tenderness are possible in the first days, which are controlled with analgesics recommended by the doctor; lukewarm sitz baths further calm the area.
Preserving the muscle for stool control is the main priority. With fistulas that pass through a larger part of the muscle, techniques that especially protect continence are chosen, sometimes in several steps. That is why the surgeon's experience and the proper choice of technique are decisive.
With simple fistulas recovery is shorter, while with techniques where the wound heals gradually the healing can take several weeks, with regular dressing changes. The exact duration depends on the complexity of the fistula and the technique applied.
A seton is a special thread that is passed through the fistulous tract. It gradually drains and manages the fistula and helps preserve the muscle for stool control, especially with more complex fistulas that pass through a larger part of the sphincter.
With simple fistulas the percentage of cure is very high. With complex, multi-tract fistulas there is a greater possibility of recurrence, so treatment is sometimes carried out in several steps. Regular follow-ups help monitor and secure the outcome.
Yes. A fistula most often arises after a perianal abscess — when a purulent collection leaves a tract toward the skin. That is why repeated abscesses in that area are often linked to the existence of a fistula that should be assessed and resolved.