Excision is the removal of an area of damaged tissue by surgically means.
Anal fistulas very rarely heal by themselves, so surgical excision is the only way they can be treated. There are several surgical options, depending on where and how complicated the fistula is. Your consultant will discuss potential treatment options and which one is best for you.
The exact procedure to surgically remove an anal fistula will depend on the size and precise location of your fistula. Options include:
This is the most common treatment for an anal fistula. The procedure involves cutting open the fistula along its whole length in order to flush out its contents. This normally heals within a few weeks leaving a flattened scar.
This technique may be suggested if your fistula passes through your anal sphincter. It avoids the need to cut the sphincter muscle which could otherwise potentially lead to the development of incontinence. The fistula is cut open and a piece of thread (a seton) is left in the fistula tract to allow it to drain.
Sometimes several operations are necessary.
This technique may also be suggested if your fistula passes through your anal sphincter. It avoids the need to cut the sphincter muscle which could otherwise potentially lead to the development of incontinence. During surgery the fistula tract is removed and the area is then covered with a piece of tissue (advancement flap) taken from inside the rectum or from skin around the anus.
The operation is effective in around 70% of cases.
This is a relatively new treatment which is currently undergoing trials. A cone-shaped plug made from human tissue is used to block the internal opening of the anal fistula. The fistula is not completely sealed so it continues to drain and new tissue grows around the plug to heal the fistula.
Initial trials show a success rate of over 80% but long term success rates are currently unknown.
Ligation of the intersphincteric fistula tract (LIFT) procedure
The LIFT procedure is another relatively new treatment for anal fistulas. The technique may be suggested if your fistula passes through your anal sphincter. The skin above the fistula is cut and the sphincter muscles are moved apart. Then the fistula is sealed at both ends and cut open so it lies flat.
Initial trials show promising results but long term success rates are currently unknown.
Currently this is the only non-surgical treatment option and it is a simple, safe and painless procedure. Fibrin glue is injected into the fistula to seal the tract before the opening is stitched closed.
Long term success rates for this method tend to be disappointing.
Surgery is normally carried out under a general anaesthetic. Afterwards, depending how you feel, you may be able to go home on the same day or you may need to stay in hospital for a few days.
You'll probably need to take at least a week off work to recover. You may have some pain after the operation, perhaps for some weeks, which we’ll help alleviate with painkillers. You may have some bleeding and problems passing urine and stools. Laxatives will be provided to ease the passing of stools.
Treatment for anal fistulas is usually completely successful and most patients tolerate it well with wounds that heal quickly. We’ll arrange to see you a few weeks after surgery to make sure the treatment has been fully successful.
The level of risk associated with the treatment of an anal fistula depends on its exact location and size, and which treatment your consultant recommends. As with any type of surgery there are some small risks, mainly:
- infection – for which you may need to take antibiotics
- recurrence of the fistula – the likely risks associated with each treatment are shown above
- bowel incontinence – severe incontinence is rare and your type of treatment will be chosen to reduce this risk
Anal fistulas very rarely heal by themselves and surgery is the only way to treat them.