Surgical treatments of anal fistula

What is an anal fistula?

Anal fistulas most commonly develop as a result of an anal abscess. It is a small tunnel that forms between the bowel and the skin near the anus. The objective of perinatal fistula surgery is the removal of the fistula and the preservation of adequate function of the sphincters, which prevents conditions such as incontinence.

Treatment of a fistula

The treatment of perianal fistula is exclusively surgical and should always be entrusted to a specialist, since the decisions made by the surgeon can have a huge impact on the future quality of life of the patient.
 

The surgeon will have a number of therapeutic options available to approach each case in an individualised manner that is agreed with the patient. In some cases, a radiological examination may be required to help make a surgical decision.
 

In recent years, perianal fistula surgery has been increasingly oriented toward less invasive surgical procedures that avoid big incisions, which in the past involved long periods of healing.
 

In many cases, the treatment of a fistula requires several procedures.
 

In the first operation a surgical grade cord known as a seton is implanted along the fistulous path. This cord is introduced through the fistula tract, joining both ends as a loop. The goal is to consolidate the path of the fistula, prevent new infections and make it easier to carry out the second surgery. This takes place after two or three months, during which time the patient can live a normal life without restriction.
 

The technique of definitive surgery depends on the preferences and experience of the surgeon. The use of biological substances to seal the path of the fistula, or the location and section through a minimal surgical incision, are some of the preferred techniques, and both provide a success rate greater than 75%.

After the fistula surgery

A perianal fistula operation does not prevent new fistulas from occurring in the future; there are cases of relapses. Nevertheless, the modern techniques that are much less aggressive mean the patients can face this situation with more optimism than previously.
 

The main advantage of this operation is that after the surgery the patient is fully recovered and after a reasonable period of rest with simple after-care treatments, the patient can return to their regular daily routine.