Anal Fistula

Anal Fistula – Treatment Overview

Introduction
An anal fistula is an abnormal tract between the anal canal and the perianal skin, most often occurring after a perianal abscess has drained spontaneously or surgically. It presents with chronic or recurrent perianal discharge, pain, swelling, and irritation. Because spontaneous healing is rare, definitive treatment is surgical, with the choice of procedure depending on the fistula’s anatomy and degree of sphincter muscle involvement.

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Treatment Options

1. Conservative / Initial Measures

• Control acute infection with incision and drainage if abscess is present.

• Antibiotics are generally not curative, but may be used if cellulitis or systemic infection is present.

2. Surgical Options

• Fistulotomy:

  • Involves laying open the fistula tract.

  • Best suited for simple, low fistulas where minimal sphincter muscle is involved.

  • High healing rates, but risk of incontinence if excessive sphincter is divided.

• Seton Placement:

  • A surgical thread or suture is passed through the fistula tract.

  • Helps maintain drainage, reduce infection, and allows fibrosis while preserving sphincter function.

  • Used in high or complex fistulas where cutting across the sphincter would risk incontinence.

• Advancement Flap Repair:

  • Involves covering the internal opening with a flap of rectal mucosa.

  • Preserves sphincter muscle; suitable for complex fistulas.

• LIFT Procedure (Ligation of Intersphincteric Fistula Tract):

  • The tract is ligated in the intersphincteric space.

  • Minimizes sphincter damage and preserves continence.

• Fibrin Glue or Fistula Plug:

  • Minimally invasive, sphincter-preserving approaches.

  • Variable success rates, usually reserved for patients not suitable for more invasive surgery.

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Supportive Care

• Sitz baths for comfort.

• Pain management (NSAIDs, local anesthetics).

• Good perianal hygiene.

• Stool softeners and high-fiber diet to reduce straining.