Patient Information Leaflet

Anal Fistula Surgery

What is an anal fistula?

An anal fistula is a small abnormal tunnel that forms between the inside of the anus (back passage) and the skin near the anus. It often develops after an abscess (a collection of pus) has drained or been treated. They can also be associated with other conditions, such as Crohn’s disease.

Common symptoms include: pain or swelling around the anus, the intermittent discharge of pus or blood, skin irritation and the formation of recurrent abscesses.

Why do I need surgery?

Anal fistulas rarely heal on their own. Surgery is usually recommended to allow the area to heal and prevent any continuing discharge and symptoms that exist at the anal verge. In addition, surgery will eliminate the fistula and prevent further abscesses from forming that may create a more complicated situation at the anal verge.

Types of surgery:

The type of operation depends on where the fistula is and how much of the anal sphincter muscle is involved. Common procedures include:

  • Fistulotomy – opening the fistula tunnel so it can heal from the inside out

  • Seton insertion – placing a thread through the fistula to keep it open and allow drainage and will require staged procedures to treat the fistula

  • Advancement flap – closing the internal opening with a flap of tissue.

We will discuss which option is best for you.

The Operation:

Surgery is performed under a general anaesthetic (you will be asleep), and usually only takes 20-30 minutes to do.

You will go home the same day or possibly stay overnight if it is late in the day.

You will have an open wound at the anal verge that will extend up inside the anal canal, the length of the wound will be determined by the length of your particular fistula. We may need to divide some sphincter muscle in order to fully lay open the entire length of the fistula track.

Risks and complications

As with any operation, there are risks, possible complications include:

  • Infection or abscess recurrence

  • Bleeding

  • Slow wound healing

  • Recurrence of the fistula

  • Rarely, changes in continence (control of bowel movements)

If you experience any issues or concerns during the post-operative period, please contact the hospital you had your surgery at on the contact number provided to you on your discharge. Alternatively, my secretary can be contacted by email (secretary@sussexsurgeon.com) or phone 07963 466976. Her working hours are between 09:00 to 16:30 Monday to Friday, except Wednesday.

After surgery

It is normal to have:

  • Some pain or discomfort (painkillers will help)

  • Light bleeding or discharge from the wound, this will continue for the length of time it takes for the wound to heal. The length of times depends on the size of the wound, but is usually between 2-3 months.

  • A dressing or pack may be placed inside the anus.

Wound care:

  • Keep the area clean – regular warm baths (sitz baths) can help

  • Change your dressings as advised by the nursing team.

  • Wear a sanitary pad or gauze to protect clothing

Returning to normal activities:

  • Most people return to work within 1–2 weeks, depending on the job

  • Avoid heavy lifting and strenuous activity for a short period.

Follow-up

You will be given a follow-up appointment to check your progress, usually between 4-6 weeks following surgery. Additional procedures may sometimes be required.

 

Andrew Day