Anal Fistula

Treatment

The goal of treatment is to cure the fistula with as little impact as possible on the sphincter muscles. The plan will depend on the fistula's location and complexity, and the strength of the patient's sphincter muscles.

Fistulotomy

The surgeon first probes to find the fistula's internal opening. Then the surgeon cuts the tract open, curettes it (scrapes and flushes out its contents), then stitches its sides to the sides of the incision so the fistula is laid open (flattened out).

To treat a more complicated fistula, such as a horseshoe fistula (where the tract extends around both sides of the body and has external openings on both sides of the anus), the surgeon may lay open only the segment where the tracts join and remove the remainder of the tracts.

If a significant amount of the sphincter muscle must be cut, the surgery may be performed in more than one stage. It may also need to be repeated if the entire tract can't be found.

Advancement Rectal Flap

Sometimes, to reduce the amount of sphincter muscle cut, a surgeon may core out the tract and then 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

The seton can also help the fistula drain.

Fibrin Glue or Collagen plug

In some cases, a doctor may use fibrin glue, made from plasma protein, to seal up 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 fistula tract can also be sealed with a plug of collagen protein and then closed.