Anal Fistula: Treatment Options
How is an anal fistula treated?
An anal fistula will not heal on its own. Although antibiotics may occasionally be effective, most persistent anal fistulas require a more aggressive approach.
Surgery
The most common treatment for an anal fistula is a surgical procedure called a fistulotomy.
In a fistulotomy, the surgeon makes an incision in the fistula tract, opening it up and merging it with the anal canal. This allows the tissues to heal from the inside out.
For very small fistulas, a fistulotomy may be performed in a doctor’s office, using only local anesthesia. Larger fistulas, however, require surgery under spinal or general anesthesia, and are typically performed in a hospital or surgery center. Patients typically experience mild or moderate discomfort or pain following this procedure, with a recovery time of one to four weeks.
Seton
Fistulotomies work well for fistulas that are relatively close to the skin. For deeper fistulas, however, the physician may choose to use a seton. A seton is a piece of suture material that is passed from the external skin opening, along the fistula tract, through the internal opening in the anal canal, exiting through the anus. The suture material is then tied in a loop, which is gradually tightened over a period of weeks. This ultimately has the same effect as a fistulotomy—to open the fistula tract and allow it to heal.
Fibrin Glue
In some cases, an anal fistula is closed by the injection of fibrin glue—a solution of the clotting factors fibrinogen and thrombin. This glue results in the formation of a clot within the fistula, which helps promote healing of the tract.
Endorectal Advancement Flap
Endorectal advancement flaps are a surgical procedure typically reserved for more complex fistulas. This surgery is often more involved and invasive than the other procedures described above. In the operating room the doctor first identifies the internal opening of the fistula. After identifying the internal opening, the doctor uses surgical instruments to dissect and lift a portion, or flap, of the rectal wall adjacent to the internanl opening. He pulls the flap down over thet internal opening and sutures it into place to close the opening, allowing the fistula to heal.
Surgisis AFP Plug
The Surgisis AFP plug is a unique alternative to traditional fistula surgery. It is a conical device made of a biomaterial that supports tissue healing. The plug is placed by drawing it through the fistula tract and suturing it in place.