Anal Fistula Surgery – Know Your Options

A fistula is an abnormal tunnel-like connection that forms between two organs or tissues that are not normally connected. In the case of an anal fistula, this connection typically develops between the skin around the anus and the anal canal. Most anal fistulas result from a previous anal abscess that did not heal properly, leading to a persistent drainage pathway. Fistulas can cause considerable discomfort and are unlikely to heal without medical intervention (i.e. anal fistula surgery). They are a common condition managed by colorectal surgeons in Singapore.

Consult A Colorectal Surgeon On Fistula Surgery Options

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Recognising The Symptoms Of An Anal Fistula

People with anal fistula may notice symptoms that should not be ignored – common ones include:

• Persistent pain and swelling around the anus
• Recurring abscesses in the anal region
• Discharge of pus or blood, which may soil undergarments
• Irritation and itching of the skin around the anus
• A visible hole or opening near the anus
• Fever or fatigue (if infection is present)

If you notice these symptoms, it’s important to seek medical advice promptly. Early diagnosis leads to better outcomes and fewer complications.

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Understanding Treatment Options

The main goal in treating an anal fistula is to remove the infected tract while preserving anal sphincter function. This helps to maintain continence and reduce the risk of recurrence. In Singapore, fistula management often begins with:

• Clinical examination and imaging, such as MRI or endoanal ultrasound
• Initial control of infection, often with antibiotics and drainage of any abscess
• Surgical intervention, which remains the definitive treatment

Let’s take a closer look at the different fistulasurgery options available in Singapore.

Types Of Fistula Surgery In Singapore

There is no one-size-fits-all approach to treating fistulas. The type of surgery depends on the complexity and location of the fistula. Here are the common surgical options:

1. Fistulotomy

This is the most common type of fistula surgery, especially for simple, low fistulas. It involves cutting open the fistula tract to allow it to heal from the inside out. It has a high success rate and is often performed as a day procedure.

Why It’s Common:
Fistulotomy is effective, safe, and straightforward, making it the first-line option for uncomplicated cases.

2. Seton Placement

For complex or high fistulas that involve a significant portion of the anal sphincter, a seton (a thin piece of surgical thread) may be placed through the fistula tract. This allows the area to drain and reduces the risk of abscess formation. It also helps to avoid cutting through the muscle.

Setons are often used in staged procedures or in combination with other treatments.

3. LIFT Procedure (Ligation of Intersphincteric Fistula Tract)

This is a sphincter-preserving surgery designed for complex fistulas. It involves accessing the fistula tract between the sphincter muscles and securely closing it off. Healing time is generally faster, and continence is maintained.

4. Advancement Flap Surgery

This procedure involves removing the internal fistula opening and covering it with a flap of healthy tissue. It is typically used when previous surgeries have failed or in recurrent cases.

5. Fibrin Glue Or Plug

These approaches do not involve cutting. Fibrin glue is injected into the fistula tract to seal it, while a collagen-based plug is used to block the opening. Although these options are less invasive, they have lower success rates compared to traditional surgery. They are usually considered in specific scenarios, such as when a patient wishes to avoid more invasive procedures.

Minimally Invasive Approaches For Fistula Surgery

1. Video Assisted Anal Fistula Treatment (VAAFT)
2. FiLAC (Laser treatment for Anal fistula)

VAAFT (Video-Assisted Anal Fistula Treatment) and FiLaC (Fistula Laser Closure) are minimally invasive treatments that use an endoscopic or laser approach to close the fistula from the inside. These techniques aim to treat the fistula without cutting the sphincter muscle, which means there is little to no risk of losing bowel control.

Success rates are generally higher in simple or low fistulas and may be lower in complex or recurrent cases. A preoperative seton placement can improve outcomes.

Consult A Colorectal Surgeon On Fistula Surgery Options

Choosing The Right Option

The choice of fistula surgery depends on several factors:

• Type and complexity of the fistula
• Location in relation to sphincter muscles
• Previous surgeries or interventions
• The patient’s overall health and preference

Your colorectal surgeon will assess your condition with detailed imaging and clinical examination to recommend the most suitable procedure.

Why Early Treatment Matters

Delaying treatment for an anal fistula can lead to complications such as:

• Recurrent infections
• Development of more complex tracts
• Abscess formation
• Potential damage to sphincter muscles

In addition, an anal fistula may be a sign of an underlying condition such as inflammatory bowel disease (IBD), especially Crohn’s disease, and should be evaluated early.

In rare cases, if left untreated, chronic and complex anal fistula can turn into cancer.

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With modern surgical techniques now widely available in Singapore, outcomes have improved dramatically. Many procedures are done as day surgeries with minimal downtime.

Contact Us For A Consultation On Fistula Surgery

Take the first step towards relief and recovery – book a consultation with a colorectal specialist today.

This medical content has been reviewed by Dr Daniel Lee, a highly experienced colorectal surgeon in Singapore, known for his expertise in minimally invasive techniques such as laparoscopic colorectal surgery, TAMIS, and advanced laser procedures for piles, fistulas, and pilonidal disease. Dr Lee is trusted for handling even the most challenging cases.

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