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The most common type of surgery for anal fistulas is a fistulotomy (NHS).

Anal fistula surgery    

An anal fistula is an abnormal tunnel that develops between the anal canal and the skin around your back passage. A fistula can be uncomfortable and unpleasant, and they don't heal without surgery. The London Clinic has world-leading surgeons that can operate to treat an anal fistula and prevent ongoing pain, discharge, and infections. 

The London Clinic's leading colorectal surgeons are experts in fistula surgery and the sensitive management of anal problems. The surgeons operate in state-of-the-art theatres, using the latest technology, and evidence-led surgical techniques. They are assisted by an expert multidisciplinary team that will support you from your first consultation, during your procedure, and throughout your recovery.

What is an anal fistula?

An anal fistula is an abnormal connection that develops between the inside of the back passage and the skin around the anus. It can leak discharge, it can cause skin irritation and infection, and it can cause pain and swelling in the area.  

Anal fistulas develop as a result of abscesses in the anal canal. When the abscess bursts, a canal can form following the track of the pus. As many as one in three people with perianal abscesses can develop a fistula. They are also more common with chronic bowel conditions, such as Crohn’s disease.

What is anal fistula surgery?

The colorectal surgeons at The London Clinic offer a comprehensive range of operations to treat anal fistulas. The right surgery for you will depend on your fistula, its size, and position, and any underlying disease. 

All anal fistula surgery aims to treat the fistula while protecting the health and function of the sphincter muscles of the anus. These help to control your bowels and maintain your continence. 

Who can benefit from anal fistula surgery?

Most anal fistulas will not heal without surgery. Anyone with an anal fistula should have surgical treatment to get rid of their fistula and resolve their symptoms. The signs and symptoms include:

An offensive discharge leaking from the skin around the back passage

  • Diarrhoea
  • Skin irritation
  • Swelling
  • Pain around the anus
  • Recurrent infections
  • A lump or hole in the skin around the back passage

Treatment options

Most anal fistulas will not heal spontaneously without surgery. Anyone with a suspected fistula should see an experienced colorectal surgeon. The London Clinic’s specialists will provide expert assessment and individual advice.

Anal fistula consultation at The London Clinic

The specialist surgeons will assess and advise you in The London Clinic's comfortable, private, and well-equipped consulting rooms. They will take a detailed medical history, examine your fistula, and ask about the impact your symptoms have on your health, wellbeing, and quality of life. 

Your consultant may arrange tests and investigations in the cutting-edge imaging suite. These may include:

  • Blood tests to exclude underlying conditions such as inflammatory bowel disease
  • Stool samples to check for inflammation
  • Swabs to check for infection
  • An internal ultrasound scan of your back passage 
  • Magnetic resonance imaging, or MRI scan
  • Computer tomography or CT scan

In consultation with you, your surgeon will then plan your admission for anal fistula surgery and advise you about any preparation needed. 

There are different procedures available. The best technique will depend on the location of your fistula and whether it affects the sphincter muscle. Your consultant will explain the options and take the time to answer all your questions. Sometimes they may need to perform a detailed examination of the fistula under anaesthestic. This is particularly necessary for people with complex or multiple fistulas.

Anal fistula surgery at The London Clinic

The surgeons at The London Clinic usually perform anal fistula surgery under general anaesthetic.  The type of procedure will depend on the position of your fistula.

Some procedures can be performed using spinal anaesthesia,  so you’ll be awake during surgery, but your lower body will be numb. 

Fistulotomy

The most commonly performed fistula surgery is suitable for simple fistulas that are below the sphincter, or that cross the muscles that make up the lower part of the sphincter muscles only. 

Your consultant surgeon will carefully place a surgical probe into the fistula. They will cut the skin and tissue above the fistula, then open up the fistula's roof. They will clean and dress the fistula, leaving it open with no stitches. It will gradually heal from the base up, with healthy tissue.

For branching or high fistulas, your surgeon may need to perform more complex or staged surgery over several months. This helps reduce the risk of damage to the anal sphincter muscles, which can lead to incontinence:

  • Seton insertion: The specialist may insert a specially designed thread called a seton through the fistula. The thread helps the fistula drain effectively, reducing infection, and aiding healing. Some fistulas will heal using setons alone; for others, it can be the first stage of treatment.
  • Staged fistulotomy: The surgeon performs a series of operations over several months. They gradually open up the fistula, inserting a seton after each procedure to aid drainage.
  • Cutting seton: A specially-designed seton can progressively cut through the muscle of the sphincter. It gradually opens the fistula while allowing the tissue to heal and form scar tissue, reducing the incontinence risk.
  • Glues and plugs: Products can sometimes be inserted into the fistula to block the canal and allow it to heal. 
  • LIFT procedure: If your fistula passed through the sphincter muscles, this procedure might be necessary. The surgeon closes one end of the fistula, then cuts the rest open, reducing damage to the sphincter.
  • Anal advancement flaps: The surgeon can create a tissue flap from the anal canal and fix it over the fistula opening. 
  • Temporary colostomy: Rarely a colostomy is necessary to rest the bowel and allow the fistula to heal.

Recovery and aftercare

Your recovery and aftercare will depend on your health and your procedure. Many people can go home on the day of surgery. However, some patients will need to stay overnight so that the team can monitor their recovery. The London Clinic's staff will provide support, arrange follow-up to assess your progress, and give you a bespoke plan to dress your wound, keep it clean and prevent infection as it heals.

Take time to rest and recover. Walk as little as possible for the first few days to help your wound heal. Over-the-counter painkillers like paracetamol and ibuprofen can help ease any pain. The area can take up to six weeks to heal. You should wear a pad to protect your clothing.

Bathing or showering regularly, up to three times a day, can keep the wound clean and soothe discomfort as well as keeping your wound clean. Gently pat the area dry afterwards and don't use any gels, soaps, or perfumed products.

Constipation can be a problem for some people. The specialist team may suggest stool-softeners or laxatives to make it easier to open your bowels. You can return to work when you can move around and sit comfortably. 

The team will always be on hand if you have any problems, worries, or questions. It's important to contact The London Clinic if you develop a fever if the area is red and inflamed if there's pus or increased bleeding.

FAQs

Can I drive after my operation? 

You should not drive after your anaesthetic. It's essential to get someone to pick you up from the clinic and escort you home. The anaesthetic can still have an impact for 48 hours, and following this, the discomfort from your wound could affect your ability to sit, drive, and respond effectively. Discuss any concerns with your consultant.

Are there complications after anal fistula surgery?

All surgery has risks. The surgeons and The London Clinic team are dedicated to reducing complications and helping your recovery. Problems with pain, bleeding, scarring, and infection can happen after any operation. 

Specific issues with anal fistula surgery include the fistula's recurrence, narrowing the anal canal, and slow wound healing. Sometimes surgery on fistulas that involve the sphincter muscles can affect bowel control, meaning you can't control passing wind or poo.  Speak to your surgeon if you have any concerns. They will always take time to discuss the pros and cons of the procedure and answer any questions.

Why choose The London Clinic?

The London Clinic is dedicated to providing the best, personalised healthcare with over 600 world-renowned consultants available to offer informed health advice and treatment.

Spanning Harley Street and Devonshire Place, The London Clinic is situated in the heart of London’s internationally-known medical district. This central location, together with state-of-the art technologies and facilities that are not widely available in other hospitals, makes The London Clinic the hospital of choice for around 120,000 patients every year.

The London Clinic is an HTA licensed and JACIE accredited cancer centre with an ‘Excellent’ MacMillan Quality Environment Mark and with access to a Level 3 intensive care unit.

Offering affordable and competitive self-pay packages and expert support from Clinical Nurse Specialists and our specialised multidisciplinary team, over 98% of our patients said they would recommend The London Clinic to their friends and families.

Treatment cost

The London Clinic offers affordable, competitive self-pay packages for certain treatments.

Patients have the option to spread the cost of treatment with Chrysalis Finance.

Please call +44 (0)20 3613 7502 to speak to our helpful team to find out more and to book an appointment.

Main numbers

General enquiries: 020 7935 4444 Appointments: 020 7616 7693 Self-Pay: 020 3219 3315

Contact numbers for service departments

Other numbers

Concierge service: 020 3219 3323International office: 020 3219 3266Invoice and payment enquiries: 020 7616 7708Press office 020 7616 7676

Your call may be recorded for training and monitoring purposes.

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