Fistula surgery has gradually moved from very invasive procedures such as fistulotomy as it is described later into less invasive procedure aimed to eradicate the fistula without compromising the function of the sphincter muscles which are vital to preserve and normal continence. We have several options with regards to surgery when we face a patient with fistula
Fistulotomy: The surgery involves cutting open the fistula across its whole length in order to flush out the contents. It heals into a flattened scar after 1 – 2 months. It is usually limited to very superficial fistula which did not cross the sphincter muscle
Seton technique: The seton technique involves passing a surgical thread into the fistula tract and leaving it in place for several months or permanently. This helps to keep the tract open and drain the contents of the fistula. This may be considered if you are at a risk of incontinence (inability for you to control your bowel movements), because your fistula crosses your sphincter muscles. These type of approach allows also the area eradication of the infection in the fistula tract to create a more stable type of fistula without an ongoing infection
Advancement flap procedures: This procedure is usually preferred if the fistula is complex or if you are at a high risk of developing incontinence. The fistula tract is removed. A small piece of tissue from the internal lining of the rectum is mobilized (advancement flap) and brought down to cover the opening of the fistula.
Bio prosthetic plug: A cone shaped plug is developed from human tissue. It is used to block the internal opening of the fistula and is sutured in place. The plug does not completely close the opening, allowing the fistula to drain.
LIFT – Ligation of Intersphincteric Fistula Tract: This relatively new procedure is a rather revolutionary approach to achieve the healing of anal fistula which consist in approaching the fistula track with a small incision and dissection of the inter sphincteric space to reach the fistula track from outside and then ligating it very close to the internal opening. The rest of the tract is cleaned and left in order to heal spontaneously.