Fistula Surgery Treatment Guide — R.K. Hospital Bhopal

Overview

An anal fistula is an abnormal tunnel-like tract that forms between the inside of the anal canal and the skin near the anus. It usually develops as a result of a previous anorectal abscess — when the abscess drains (naturally or surgically), it can leave behind a chronic track that fails to heal. Patients experience recurring discharge of pus, pain, and swelling near the anus. At R.K. Hospital & Research Centre, we treat anal fistulas using various surgical techniques tailored to the fistula type and complexity. Options include fistulotomy (laying open the tract), fistulectomy (complete excision), LIFT procedure (ligation of intersphincteric fistula tract) for complex fistulas, and seton placement for high or trans-sphincteric fistulas. Dr. Rajesh Kanungo, with 34 years of experience and expertise in anorectal surgery, ensures the right technique is chosen to maximise healing while preserving anal sphincter function and continence.

Who Needs Fistula Surgery?

• •Patients with a persistent draining sinus or pus discharge near the anus following a previous anorectal abscess
• •Individuals with recurrent perianal swelling, pain, and discharge that comes and goes over weeks or months
• •Patients diagnosed with an anal fistula on clinical examination or MRI fistulogram
• •Those with fistula-related symptoms including itching, irritation, and soiling of undergarments due to discharge
• •Patients with complex or recurrent fistulas that have not healed after previous surgery

How to Prepare

1. 1Clinical examination by the surgeon — a probe may be gently passed to assess the fistula tract
2. 2MRI fistulogram for complex fistulas to map the tract, identify branching, and determine the relationship with the anal sphincter muscles
3. 3Basic blood tests including complete blood count, blood sugar, and coagulation profile
4. 4Inform the surgeon about any history of inflammatory bowel disease (Crohn's disease), diabetes, or previous anorectal surgeries
5. 5Follow a light diet the day before and an enema may be given on the morning of surgery to clear the rectum

What Happens During the Procedure

1. 1The surgery is performed under spinal or general anaesthesia with the patient in the lithotomy position
2. 2The fistula tract is identified by passing a probe from the external opening to the internal opening inside the anal canal
3. 3For simple fistulas (fistulotomy): the tract is laid open by cutting the tissue over the probe, and the tract is curetted and left to heal from inside out
4. 4For complex/high fistulas (LIFT procedure): the fistula tract is identified in the intersphincteric plane, ligated on both sides, and divided to close both openings while preserving the sphincter
5. 5For very high or recurrent fistulas: a seton (a loose thread) may be placed through the tract to allow gradual drainage and staged treatment
6. 6The wound is dressed with antiseptic packing and the patient is monitored in recovery

Recovery & Aftercare

• ✓Hospital stay is 1–2 days; simple fistulotomy patients may go home the same day
• ✓Sitz baths (sitting in warm water for 15–20 minutes) 3–4 times daily after the procedure to keep the wound clean and promote healing
• ✓The wound heals by secondary intention (from inside out) over 4–8 weeks; daily dressings may be needed initially
• ✓Take prescribed antibiotics and stool softeners to prevent constipation and straining during healing
• ✓Avoid prolonged sitting, cycling, and heavy lifting for 2–3 weeks
• ✓Follow-up visits at 1 week, 2 weeks, and monthly until the wound is fully healed to monitor for recurrence

Risks & Considerations

Like any medical procedure, there are some risks. Your doctor will discuss these in detail during consultation.

• ⚠Recurrence of fistula — occurs in approximately 5–15% of cases depending on complexity; minimised with correct surgical technique and complete tract treatment
• ⚠Partial incontinence (difficulty controlling gas or minor leakage) — rare with sphincter-preserving techniques like LIFT and careful fistulotomy
• ⚠Wound infection — managed with antibiotics and regular sitz baths
• ⚠Delayed healing — more common in patients with diabetes or those who do not follow wound care instructions
• ⚠Bleeding from the wound — usually minor and controlled with pressure

Cost in Bhopal

Frequently Asked Questions