Anal Fistula

Treatment

Mayo Clinic offers various surgical approaches to remedy anal fistulas. The surgical procedure and your individual treatment plan will depend on the anal fistula's location and complexity.

Mayo Clinic's treatment goals are to:

• Heal the fistula with as little impact as possible on the sphincter muscles
• Relieve symptoms
• Avoid affecting bowel emptying
• Avoid reinfection

Fistulotomy

The surgeon finds the fistula's internal opening, cuts the channel (tract) open, scrapes and flushes out its contents and flattens it by stitching its sides to the sides of the incision.

To treat a more complicated fistula the surgeon may lay open only the segment where the channels join and remove the remainder of the channels.

The operation may need to be done in two stages if a significant amount of sphincter muscle must be cut, or if the entire channel can't be found.

Advancement rectal flap

Sometimes, to reduce the amount of sphincter muscle cut, a surgeon may core out the tract and cut a flap into the rectal wall to access and remove the fistula's internal opening. The flap is then stitched back down.

Seton placement

The surgeon uses a seton (silk string or rubber band) to either:

• Create scar tissue around part of the sphincter muscle before cutting it with a knife.
• Allow the seton to slowly cut all the way through the muscle over the course of several weeks.

A seton is often used to help the fistula drain.

Fibrin glue and collagen plug

In some cases, the surgeon may use fibrin glue, made from plasma protein, to seal and heal a fistula rather than cutting it open. The doctor injects the glue through the external opening after clearing the tract and stitching the internal opening closed. The anal fistula tract can also be sealed with a plug of collagen protein and then closed.

Ligation intersphincteric fistula tract (LIFT)

LIFT is a new treatment being performed at Mayo Clinic in Florida for more complex or deep fistulas that cannot be treated with simple fistulotomy. The first step involves placing a seton into the fistula tract. Several weeks later, when the tract has thickened, the surgeon divides the fistula tract without dividing the muscle and closes the internal fistula opening.

Ostomy/stoma

The surgeon creates a temporary opening in the abdomen to divert waste (which is collected in a bag) and allow the anal area time to heal.

Muscle flap

In very complex anal fistulas, the area between the two fistula openings is filled in with healthy muscle tissue harvested from the thigh, labia or buttock.