Treatment of anal fistula depends on the fistula's location and complexity. The goals are to repair the anal fistula completely to prevent recurrence, and to avoid damaging the sphincter muscles, which can lead to fecal incontinence.
The options include:
The surgeon cuts the fistula's internal opening, scrapes and flushes out the infected tissue, then flattens the channel and stitches it in place. To treat a more complicated fistula, the surgeon may need to remove some of the channel. Fistulotomy may 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
The surgeon creates a flap from the rectal wall before removing the fistula's internal opening. The flap is then used to cover the repair. This procedure can reduce the amount of sphincter muscle that is cut.
The surgeon places a silk string (seton) into the fistula to help drain the infection.
Fibrin glue and collagen plug
The surgeon clears the channel and stitches shut the internal opening. Special glue made from a fibrous protein (fibrin) is then injected through the fistula's external opening. The anal fistula tract also can be sealed with a plug of collagen protein and then closed.
Ligation of the intersphincteric fistula tract (LIFT)
LIFT is a two-stage treatment performed at Mayo Clinic in Florida for more complex or deep fistulas. LIFT allows the surgeon to access the fistula between the sphincter muscles and avoid cutting them. A seton is first placed into the fistula tract, forcing it to widen over time. Several weeks later, the surgeon removes infected tissue and closes the internal fistula opening.
Ostomy and stoma
The surgeon creates a temporary opening in the abdomen to divert waste into a collection bag, to allow the anal area time to heal.
In very complex anal fistulas, the channel may be filled with healthy muscle tissue from the thigh, labia or buttock.