Surgery for an anal fistula

These operations are done by a clinician. ahem does not perform them. How a fistula differs from a tear is on an anal fissure and an anal fistula.

Mayo Clinic dates its treatment page July 2, 2024. Opened October 27, 2026, it says treatment depends on the fistula's location, complexity, and cause. The goals are to repair the fistula completely, to prevent recurrence, and to protect the sphincter muscles. Damage to those muscles can lead to fecal incontinence. Surgery is usually required. Nonsurgical treatments are sometimes an option.

Cleveland Clinic last updated its page on July 11, 2023. On the copy opened October 27, 2026, most anal fistulas require surgery. Healing that happens on its own is usually followed by infections and abscesses that reopen the tunnel. If inflammatory bowel disease caused the fistula and it is not infected, Cleveland Clinic says it will occasionally heal with medical treatment, and that a clinician might try an immunomodulator such as infliximab before surgery. That drug name is Cleveland Clinic's example. This page does not add a dose.

Cleveland Clinic calls a fistula simple when it involves only a minimal amount of muscle and has no branches. The operation it names is a fistulotomy. The surgeon cuts through the roof of the fistula so it can fill in from the bottom, and may remove infected tissue. Cutting the roof may cut a small amount of muscle. Cutting too much risks bowel control. On the page checked October 27, 2026, Cleveland Clinic calls this the most effective treatment for an anal fistula, about 95 percent.

Mayo Clinic describes fistulotomy as cutting the internal opening, scraping and flushing infected tissue, then flattening the tunnel and stitching it. For a more complicated fistula, the surgeon may remove some of the tunnel. Fistulotomy may be done in two stages if a significant amount of sphincter must be cut, or if the whole tunnel cannot be found. Mayo Clinic does not print the 95 percent figure.

Cleveland Clinic calls a fistula complex when it involves a significant amount of muscle, has branches, or the person has conditions that raise the risk of complications. Those may need more than one operation. Three techniques are on the page checked October 27, 2026.

A seton, on that page, is surgical thread that is not absorbed and has to be removed. The surgeon loops it through the tunnel so the discharge can drain. It can also cut slowly through the tract, or be left in place indefinitely when inflammatory bowel disease is the cause. An endorectal advancement flap covers the inside opening with tissue from the rectal wall so the sphincter is not cut open along the roof. Cleveland Clinic calls that procedure about 70 percent effective, and says there is still an approximate 30 percent risk of injuring the sphincter when the flap is cut. LIFT, ligation of the intersphincteric fistula tract, closes the part of the tunnel that passes between the sphincter muscles, usually after a seton. Cleveland Clinic calls LIFT a little less effective than fistulotomy, at 75 percent, and says it does not risk harming the sphincter muscles.

Mayo Clinic's descriptions of the same three operations, on the July 2, 2024 treatment page, do not include those percentages. Its seton for LIFT is a silk or latex string placed first, so the tunnel widens over several weeks before infected tissue is removed and the internal opening is closed. Its separate nonsurgical seton is placed to drain infection and may be combined with surgery. Its advancement flap is a flap of rectal wall used to cover the repair, so less sphincter is cut.

Mayo Clinic also names fibrin glue and a collagen plug. The surgeon clears the tunnel, stitches the internal opening, and injects glue made from fibrin, or seals the tunnel with a collagen plug. Medication may be part of treatment when Crohn's disease is the cause. For a complex fistula, Mayo Clinic names a temporary ostomy, which diverts the intestine to an opening on the abdomen, and a muscle flap from the thigh, labia, or buttock. Cleveland Clinic's fistula page opened the same day does not describe glue, a plug, an ostomy, or a muscle flap.

How long a fissure page gives home care before medicine or sphincter surgery is a different problem. That timeline is on how long an anal fissure takes to heal. Hemorrhoid removal is a different operation, on hemorrhoidectomy and hemorrhoid stapling.

Mayo Clinic's self-care list, checked October 27, 2026, is pain medication as needed, a soak in a warm sitz bath, fiber and plenty of liquid to prevent constipation, and avoiding strain. It does not give a water temperature, a minute count, or a number of soaks.

Cleveland Clinic says these procedures are generally outpatient, so a person goes home the same day, and some people return for more surgery later. On the page checked October 27, 2026, recovery from one or several operations is three to six weeks. Instructions it lists are fiber supplements taken with lots of water, because pain medicine can cause constipation; a warm, shallow sitz bath at least once a day; and dressings to collect drainage. It does not give a minute count for that bath either. The three-to-six-week span is Cleveland Clinic's. Mayo Clinic does not print it.