Treating anal fistulas typically requires a surgical approach, as they rarely heal on their own. The primary goal of treatment is to remove the fistula tract, prevent recurrence, and preserve anal sphincter function to avoid complications like incontinence. The choice of surgery depends on the fistula’s complexity, depth, location, and the patient’s overall health. Below are the most commonly used surgical procedures for treating anal fistulas:

1. Fistulotomy

A fistulotomy is the most common and straightforward procedure for treating simple, low-lying fistulas. In this procedure:

• The surgeon opens the entire length of the fistula tract by cutting along it.

• The tract is then flattened and left open to heal naturally from the inside out.

• Healing typically takes a few weeks, with regular dressing changes.

• Advantages: High success rate, minimal recurrence, suitable for simple fistulas.

• Risks: Minor risk of incontinence if the sphincter muscle is involved.

2. Seton Placement

A seton is a surgical thread or rubber band placed through the fistula tract, often used when:

• The fistula passes through a significant portion of the sphincter muscle, making direct cutting risky.

• The seton helps keep the fistula open for drainage, preventing abscesses and reducing infection.

• It may be left in place for several weeks or months to promote healing and may be followed by definitive surgery.

• There are two types: loose setons (for drainage) and cutting setons (gradually cut through the tissue).

• Advantages: Allows drainage without sphincter damage; useful for complex cases.

• Risks: Discomfort, long treatment duration.

3. Advancement Flap Procedure

This procedure is ideal for complex or high fistulas, where preserving sphincter function is critical. It involves:

• Closing the internal opening of the fistula with a flap of healthy tissue, usually taken from the rectum or anal canal.

• The external opening is cleaned and left to drain.

• The goal is to block the fistula from inside, allowing it to heal without cutting the sphincter.

• Advantages: Suitable for complex fistulas, minimal risk to continence.

• Risks: Slightly higher risk of recurrence compared to fistulotomy.

4. LIFT Procedure (Ligation of Intersphincteric Fistula Tract)

The LIFT procedure is a minimally invasive technique that targets fistulas without cutting the anal sphincter muscle:

• The surgeon accesses the fistula between the sphincter muscles, identifies the tract, and ties it off (ligates).

• The infected tissue is removed, and the internal opening is closed.

• Recovery is quick with minimal discomfort and risk to sphincter function.

• Advantages: High success rate, low risk of incontinence, effective for medium to complex fistulas.

• Risks: Not suitable for all fistula types, mild recurrence possible.

5. Laser Surgery (FiLaC – Fistula Laser Closure)

Laser treatment is a modern, minimally invasive option that uses laser energy to seal the fistula from the inside:

• A laser probe is inserted into the fistula tract.

• Laser energy shrinks and seals the tract, promoting healing without cutting tissue.

• It’s painless, has a short recovery period, and can often be done as a daycare procedure.

• Advantages: No cuts or stitches, minimal pain, preserves sphincter function, quick return to normal activities.

• Risks: Slightly higher cost; success rates can vary depending on fistula complexity.

Choosing the Right Treatment

The best treatment option is determined based on:

• Type and complexity of the fistula

• Involvement of sphincter muscles

• Risk of recurrence or complications

• Patient preference, lifestyle, and health condition

Consulting a specialized proctologist or colorectal surgeon ensures the most effective and safest treatment outcome. Early intervention typically leads to better recovery and fewer complications.