Surgery for anal fistula (2024)

What is an anal fistula?

An anal fistula is an abnormal connection between the lining on the inside of your anal canal (back passage) and the skin near your anus.

Most anal fistulas are caused by an abscess (a collection of pus) that has developed in your anal canal. The pus can drain away onto your skin on its own or by an operation. A fistula happens when the track made by the pus on the way to the surface of your skin stays open.

What are the benefits of surgery?

You should no longer have any infection or pain.

Are there any alternatives to surgery?

Most anal fistulas do not heal without surgery.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation usually takes 15 to 30 minutes.

To lessen the risk of bowel incontinence (when you pass a bowel movement without wanting to) your treatment may involve several operations over a number of months.

The type of surgery you need will depend on where the fistula is.

  • If the fistula is below or crosses the lower part of the sphincter muscles (the muscles around your anal canal that control when you open your bowels), your surgeon will cut the fistula open to your skin and leave your wound open so that it can heal with healthy tissue.
  • If the fistula has branches that pass through the upper part of the sphincter muscles, your surgeon may instead place a special stitch (called a seton stitch) in the fistula to allow pus to drain easily. The fistula may be suitable for treatment with special glue, clips or a plug made from pig-bowel tissue.
  • If the fistula reaches above your sphincter muscles, you may need to have a temporary colostomy (your large bowel opening onto your skin). However, this is not common.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

  • bleeding
  • infection of the surgical site (wound)
  • allergic reaction to the equipment, materials or medication
  • chest infection

Specific complications of this operation

  • difficulty passing urine
  • involuntarily passing wind or loose faeces
  • bowel incontinence

Consequences of this procedure

  • pain
  • unsightly scarring of your skin

How soon will I recover?

You should be able to go home the same day or the day after.

Rest for a few days, walking as little as possible, to help your wound to heal.

You should be able to return to work as soon as you can move about and sit freely.

The wound often takes several weeks to heal completely and you may need to wear a pad until then.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a full recovery and can return to normal activities. For a small number of people the fistula can come back.


An anal fistula can cause continued infection and pain. Symptoms usually get worse without surgery.


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Surgery for anal fistula (2024)


Surgery for anal fistula? ›

Fistulotomy. The surgeon cuts the fistula's internal opening, scrapes and flushes out the infected tissue, and then flattens the tunnel and stitches it in place. To treat a more complicated fistula, the surgeon may need to remove some of the tunnel.

Is fistula surgery a major surgery? ›

In fact fistulotomy is a minor outpatient surgery and you can be on your way home the same day of your surgery. Before we delve into fistulotomy procedure, let's understand what causes a fistula to grow. What is fistula? In simple words, a fistula refers to an abnormal connection between any two surfaces.

How long does fistula surgery take to heal? ›

Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take several weeks to several months for your fistula to completely heal. This depends on the size of your fistula and how much surgery you had.

How urgent is fistula surgery? ›

People can usually manage their fistulas with elective outpatient surgeries. An exception is aortoenteric fistulas, which require immediate attention through emergency surgeries.

What is the best surgery method for fistula? ›

The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up, so it heals as a flat scar. A fistulotomy is the most effective treatment for many anal fistulas.

How long is hospital stay for fistula surgery? ›

Most people can leave hospital on the same day as the surgery. You need a family member or friend to travel home and stay with you for at least 24 hours after your surgery. It is important that you rest for the remainder of the day.

What is the life expectancy of a fistula patient? ›

However, the calculated survival of AVFs would be attenuated when patients with AVF nonmaturation are also involved. This evidence was confirmed by the present study, which included both mature and nonmature AVFs for data analysis and found that the overall median survival of fistulas was only 3.1 years.

What will happen if a fistula is left untreated? ›

These are more difficult to surgically repair. In addition, recurrent fistulas are not only painful, but can compromise your immune system. Delaying treatment can cause the development of more abscesses. An untreated fistula can lead to systemic infections which can spread to other parts of the body.

What is the main cause of fistula? ›

A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result of an injury or surgery. Infection or inflammation can also cause a fistula to form.

Is it OK to live with fistula? ›

While rarely life-threatening, fistulas can decrease people's quality of life and often need combined medical and surgical treatment. This information sheet provides some general information about fistulas and likely treatments. It also includes tips and suggestions which may help you if you are living with a fistula.

Are you awake during fistula surgery? ›

The most common fistula repair procedure is fistulotomy surgery. If this procedure is right for you, here's what to expect: We give you general anesthesia, meaning you will be asleep and not able to feel any sensation during your procedure.

Is fistula surgery high risk? ›

The risk depends on the position of the fistula and the type of surgery used to remove it. The risk is highest for Seton techniques (approximately 17%) and the advancement flap procedure (about 6-7%).

Can a fistula burst? ›

It is rare for a fistula /graft to bleed excessively after dialysis, but it does happen and can lead to rupture. The good news is that there are often warning signs. You need to know them and be ready to respond.

How painful is fistula surgery? ›

Most people have very little pain after several days. But it usually takes several weeks for the area to completely heal. After the area heals, the fistula will be gone. You will probably be able to return to work or your normal routine in 1 to 2 weeks.

Which doctor is best for fistula? ›

A Proctologist is a specialist who deals with anorectal conditions like fistula, piles, fissure etc. These conditions are otherwise treated by general surgeons, the doctors who normally treat conditions like appendicitis, hernias, gall-bladder stones etc.

Which is better laser or open surgery for fistula? ›

The results showed that the laser group had a shorter time to return to work and less postoperative pain compared to the fistulotomy group. However, the recurrence rate was higher in the laser group.

How serious is a fistula? ›

Fistula tracts must be treated because they will not heal on their own. There is a risk of developing cancer in the fistula tract if left untreated for a long period of time. Most fistulas are simple to treat. Either the tract or fistula can be opened or the tract and the pocket inside are completely removed.

What is the success rate of fistula repair? ›

The overall success rate per procedure was 60%, with no difference in recurrence rates based on the type of repair. Patients with Crohn's disease had more recurrent fistulas (44.2% success per procedure; P < . 01), although 78% eventually healed after an average of 1.8 procedures.

Can I walk after fistula surgery? ›

It is important that patients are able to rest for several days following the surgical procedure. During this time, they should allow their bodies to recover, and avoid sitting or walking for too long. Many people find it more comfortable to wear loose-fitting clothes during the recovery period.

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