There are several different procedures to treat an anal fistula and the surgery will be performed by a colon or rectal surgeon. The goal of the surgery is to heal the fistula while avoiding damage to the sphincter muscles, which could result in loss of bowel control. Your surgeon will discuss the best option suitable for you. It usually depends on where the fistula is and whether it is a single channel or branches off in different directions. To help determine the best treatment for you, you may need to have an initial examination of the area. Anal fistula surgery is performed under local or general anesthetic.
Fistulotomy is the most common type of surgery to treat an anal fistula. During this procedure, your surgeon will make an incision along the whole length of the fistula in order to open it up so it can heal as a flat scar. Although it is the most effective treatment for many anal fistulas, it is only suitable for fistulas that do not pass through much of the sphincter muscles. Sometimes, your surgeon may have to cut a small portion of anal sphincter muscles. When they do it, they will make an attempt to reduce the risk of incontinence. If the risk of incontinence is too high, your surgeon may recommend another procedure.
Seton techniques are performed when your fistula passes through a significant portion of anal sphincter muscles. With this technique, your surgeon will insert a Seton. A Seton is a piece of surgical thread that is left in the fistula for several weeks to keep it open, which will allow it to drain and to help it heal without cutting the sphincter muscles. A loose Seton will allow the fistula to drain but will not cure it. To cure the fistula, your surgeon may use tighter Setons to cut through the fistula slowly.
Advancement flap procedure may be considered by your surgeon if your fistula passes through anal sphincter muscles. During this procedure, your doctor will cut or scrape out the fistula. Then they will cover the hole where it entered the bowel with a flap of tissue taken from inside the rectum. However, this procedure has a lower success rate than a fistulotomy.
LIFT procedure, or the ligation of the inter-sphincteric fistula tract, is a treatment for fistulas that pass through the anal sphincter muscles. Your surgeon will make a cut on the skin above the fistula to open it up and the sphincter muscles are moved apart. Then, the fistula is sealed at both ends and cut open so it lies flat. This is one of the newest procedures to treat an anal fistula.