Anal Fistula Surgery

Anal fistula necessarily requires a surgery because they don’t heal on their own if they are left untreated.

There are various options available for the surgery which will depend on the position of the fistula in relation to the anal sphincter. The surgeon may have to perform an initial examination of the area under local or general anaesthesia to pinpoint and determine the best treatment. The suitable option is then determined.

Surgery is generally done under general anaesthesia. The goal of the surgery is the treatment of the fistula without damaging the sphincter muscles and thereby preventing bowel incontinence.

The main options are given below:

Surgical options:

• Fistulotomy - It is a process in which the surgeon cuts open the whole length of the fistula so as to convert the tunnel into an open groove. This allows the fistula tract to heal up. This procedure can only be done for fistulas with no or very less sphincter involvement.
• Seton techniques– this is usually done when the fistula crosses through a large part of the anal sphincter muscle. The surgeon inserts a seton, which is a piece of surgical thread, inside the fistula and leaves it there for several weeks so as to keep the fistula open. This allows it to drain the content inside and slowly heal. It avoids operating on the sphincter muscles. A tighter Seton can be used to cut through the fistula gently. However, this requires multiple procedures and operations.
• Advancement flap procedure– this procedure is only carried out when the fistula passes through the sphincter muscles in the anus which makes Fistulotomy a risky procedure as it may cause incontinence. A flap is taken from the rectum or the skin around the anus. This flap is attached to the opening of the fistula after it is removed.
• LIFT procedure– It stands for the Ligation of the Intersphincteric Fistula Tract. It is recommended for the fistulous that pass through the sphincter muscles of the anus.

Non-surgical options:

• Fibrin Glue– Fibrin glue treatment is the only non-surgical way available. Glue is used to seal the tract by injecting it inside the fistula and the opening is stitched closed. Although, it is not a permanent cure and not as effective as other treatments and surgeries. It still can be a useful option where fistulotomy is risky and the fistula passes through the sphincter muscles.
• Cholecystectomy - Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of gallstones and other gallbladder conditions.
• Laparoscopic Cholecystectomy- A laparoscopic surgery, also known as “minimally invasive surgery” or “keyhole surgery”, is a procedure wherein instead of one large incision, a few small incisions are made through which a laparoscope and the instruments for performing the surgery are inserted. A laparoscope is a thin tube with a camera attached in the front. Abdomen is inflated with carbon dioxide gas, so that internal organs can be visualised easily through the camera. The gallbladder is removed and the openings are closed with sutures, clips or glue.
• Open Cholecystectomy - An open cholecystectomy is the removal of the gallbladder through an approximately 6 inches incision in the right upper abdomen.An open

cholecystectomy might be required instead of a laparoscopic cholecystectomy because of:

• Past abdominal surgery
• Cirrhosis of liver
• Gallbladder cancer
• A condition that would make it difficult to see through the laparoscope