Anal Fistula Surgery: What to Expect

Anal fistula surgery addresses abnormal tunnels (fistulas) that form between the anal canal and the skin near the anus. This surgical procedure removes the fistula tract while preserving the anal sphincter muscles to maintain proper bowel control. The surgery aims to eliminate infection, promote proper healing, and prevent the recurrence of the fistula.

This guide outlines the key aspects of anal fistula surgery and what patients can expect during their treatment.

Why Surgery May Be Recommended

Surgery is often recommended for anal fistulas when the condition fails to heal on its own or causes persistent symptoms. Key indicators for surgical intervention include:

Persistent Anal Discharge: Continuous drainage of pus or blood from an opening near the anus signals the presence of a fistula that requires surgical treatment.

Recurrent Abscess Formation: Multiple episodes of painful swelling and infection in the anal area suggest an underlying fistula that necessitates surgical correction.

Failed Conservative Treatment: If non-surgical approaches, such as antibiotics and wound care, do not resolve the fistula, surgery becomes necessary.

Pain and Discomfort: Ongoing anal pain, particularly during bowel movements or prolonged sitting, indicates the need for surgical intervention.

Advantages of Surgical Treatment

Surgical treatment for anal fistulas offers several benefits, enabling patients to regain their normal routines and improve overall well-being:

Complete Tract Removal: Surgery effectively removes the entire fistula tract, eliminating the source of infection, drainage, and discomfort.

Reduced Risk of Recurrence: By properly closing or addressing the fistula tract, surgery significantly lowers the chances of the condition returning.

Symptom Relief: Surgical intervention resolves both the underlying cause and symptoms, including persistent discharge, pain, and recurring infections.

Enhanced Quality of Life: Successful treatment allows patients to resume daily activities without the ongoing challenges and discomfort associated with anal fistulas.

Surgical Techniques for Treating Anal Fistulas

Several surgical approaches are available for treating anal fistulas, with the choice of technique depending on the fistula’s location and complexity:

Fistulotomy
In this procedure, the surgeon opens the entire fistula tract, removes infected tissue, and allows the wound to heal from the inside out. This technique is best suited for simple, low-lying fistulas and carries minimal risk to the sphincter muscles.

Seton Placement
The surgeon inserts a thin, flexible material through the fistula tract. This method facilitates drainage of infection while gradually cutting through the tract, allowing the surrounding tissue to heal. It is particularly effective in preserving sphincter function.

LIFT Procedure
The Ligation of Intersphincteric Fistula Tract (LIFT) involves accessing the fistula between the sphincter muscles, excising the infected tract, and closing the internal opening. This technique is advantageous for complex fistulas as it helps preserve sphincter integrity.

Advancement Flap
In this approach, the surgeon creates a flap of healthy tissue to cover the internal opening of the fistula. This technique is suitable for high fistulas and helps maintain sphincter muscle integrity during the healing process.

Preparing for the Procedure

Preparation for anal fistula surgery involves several key steps to ensure a safe and successful outcome.

Medical Assessment
A thorough physical examination, along with imaging studies, is conducted to determine the exact path and complexity of the fistula. Blood tests are also performed to assess your overall health and identify any underlying conditions that may affect the procedure.

Medication Review
Your surgeon will review all current medications and supplements you are taking. You may need to adjust or temporarily discontinue any blood-thinning medications prior to surgery to minimise the risk of excessive bleeding.

Bowel Preparation
To ensure a clear surgical field, you will need to follow specific dietary restrictions and take prescribed bowel-cleansing solutions. This preparation typically begins 24 to 48 hours before the procedure and is necessary for optimal results.

Fasting Guidelines
You should refrain from eating solid foods for at least 8 hours before surgery and consume only clear liquids for 2 hours prior. Adhering to these fasting guidelines helps reduce risks associated with anaesthesia.

Step-by-Step Procedure

Anaesthesia Administration
The anesthesiologist administers either regional or general anaesthesia, depending on the surgical technique and individual patient factors. Monitoring equipment is used throughout the procedure to track vital signs and ensure patient safety.

Fistula Examination
The surgeon examines the fistula using specialised probes to confirm its path and identify any secondary tracts. This step is required to ensure that all affected areas are treated comprehensively.

Tract Treatment
Using the selected surgical technique, the surgeon removes or treats the fistula tract. This may involve cutting the tract, placing setons, or creating tissue flaps, depending on the chosen method.

Wound Closure
After treatment, the surgeon determines whether to leave the wound open for healing from the inside out or to close it partially. This decision is based on the surgical technique used and the assessed risk of recurrence.

Recovery and Aftercare

Initial Recovery
The first 24-48 hours focus on pain management and monitoring for complications. Patients typically go home the same day or after an overnight stay, depending on the procedure.

Activity Resumption
Light activities resume within a few days, while full recovery takes 4-6 weeks. Gradual return to normal activities prevents wound complications and promotes proper healing.

Follow-up 
Regular check-ups monitor healing progress and address any concerns. Initial visits occur weekly, then space out as healing progresses.

Potential Risks and Complications

Anal fistula surgery carries risks such as temporary bowel control changes, wound infection, bleeding, and fistula recurrence. Some patients may experience difficulty with complete wound healing or develop minor scars in the anal area. Changes in bowel habits typically resolve as healing progresses.

Conclusion

While anal fistula surgery requires careful preparation and dedicated recovery time, the procedure offers an effective solution for patients experiencing ongoing symptoms. Through proper surgical intervention and adherence to post-operative care guidelines, most patients achieve relief from fistula-related symptoms and regain their quality of life. 

Schedule a consultation today for a detailed evaluation of your condition and tailored treatment recommendations.