A perianal fistula is an abnormal tract between the anal canal and the skin. Treatment is individualised to its course and sphincter involvement: from simple fistulotomy to sphincter-preserving techniques (seton, LIFT, flap).
What does it involve?
It treats a perianal fistula — an abnormal tract between the anal canal and the skin, usually after an abscess. The fundamental goal is twofold: healing the fistula while preserving continence.
The choice of technique depends on the tract's relation to the sphincter (low vs complex/high fistula).
When is it needed?
It is indicated for a symptomatic fistula (discharge, recurrent abscess, discomfort). Classifying it as simple or complex determines the strategy; complex/high fistulas require sphincter-sparing techniques.
Preparation
For complex or recurrent fistulas, a pelvic MRI maps the tract and any secondary extensions — crucial for planning. A proctological assessment and exclusion of underlying disease are done.
How it's done
For simple, low fistulas, fistulotomy (laying the tract open) offers high cure rates. For complex/high ones, where continence preservation is the priority, sphincter-sparing techniques are used: a seton (draining or cutting), LIFT and an advancement flap.
A staged strategy is often followed for safe healing without jeopardising the sphincter.
Fistulotomy
Laying open the tract for low fistulas — high cure with minimal sphincter involvement.
Seton
A thread that drains and matures the fistula, protecting the sphincter — often an interim step.
LIFT / Flap
Techniques that close the fistula without cutting the sphincter — for high/complex fistulas.
Recovery
Recovery varies with the technique. Sitz baths, stool regulation and local care are advised; a seton may remain in place for a period as part of staged management.
Risks & outcomes
Main concerns: recurrence and continence disturbance — competing goals balanced by the appropriate, individualised technique. Correct mapping and a sphincter-sparing approach in complex fistulas are decisive.
Frequently asked questions
Will my continence be affected?
For complex/high fistulas, sphincter-preserving techniques (seton, LIFT, flap) are used precisely to protect continence.
Why might several stages be needed?
In complex fistulas, a seton matures and drains the fistula first, so the definitive operation can be done more safely at a second stage.
Will the fistula close on its own?
No — an established fistula does not close without surgery and tends to recur as an abscess.
Is an MRI needed?
For complex or recurrent fistulas, MRI helps with precise mapping and choosing the right technique.