The majority of anal fistulae can be easily treated, however this treatment needs to be performed by an expert.
The most effective treatment involves cutting through the fistula and a small amount of the muscle of the bottom known as the sphincter muscle. This is known as ‘laying open’. This has the highest chance of cure but is not suitable to treat all fistulas as sometimes it can result in minor incontinence.
In this situation, the surgeon may recommend placing a thread through the fistula. This allows the fluid to drain without collecting around the anus. This procedure is called placing a seton. This does not heal the fistula but allows the symptoms to settle before more definitive surgery can be offered.
In rare cases the fistula can be more complex to treat. Under these circumstances your surgeon will discuss other treatment options with you. It is important to understand that you may require multiple operations to treat the fistula under these circumstances.
Minimally invasive options include the use of a fistula plug, laser treatment or video assisted treatment irrigation and washing of the fistula tract. All of these treatments are available at OneWelbeck and which procedure is suitable for any fistula will depend on characteristics of the fistula. More invasive treatments include procedures to remove the fistula tract, known as a LIFT procedure or a plastic surgery procedure called an advancement flap.
If you have Crohn’s disease, the treatment of fistulas can be quite different. The general principles remain the same, with the use of surgery to control and treat infection and to define the anatomy of the fistula. However, patients with Crohn’s will be started on medication once the infection has resolved to try and heal the fistula. The surgeons at OneWelbeck will refer you to a gastroenterologist for comprehensive care.
Whichever treatment you have, if you smoke you should stop as this will promote healing.