An anorectal fistula is an abnormal tunnel that forms between the inside of your anus or rectum and the skin around your bottom. It often starts as an infection or abscess (a painful collection of pus), which creates a tract that doesn’t heal on its own.

When the fistula has multiple openings, passes through a large portion of the muscle that controls bowel movements, or is linked to other health conditions (like Crohn’s disease), it is called a complex fistula.

Why Surgery is Needed

A complex fistula will not go away on its own. Surgery is done to:

• Remove the infected or abnormal tissue

• Help the area heal properly

• Prevent infections or abscesses from coming back

• Protect your ability to control bowel movements (continence)

Types of Surgery for Complex Fistulas

There are different surgical options, depending on how deep or complicated your fistula is. Your surgeon will choose the best option for your specific case. These may include:

1. Seton Placement

A soft thread or rubber band (called a seton) is placed through the tunnel to keep it open and allow it to drain. This helps reduce infection and prepares the fistula for further treatment later.

2. LIFT Procedure

This involves closing off the inside of the tunnel from within the layers of the muscle without cutting any major muscle. It is a good option for fistulas that go deep through muscle.

3. Flap Repair

In some cases, the opening inside the rectum is closed using a small flap made from your own tissue. This seals the fistula while protecting the muscle.

4. Fistula Plug or Glue

A special plug or glue is inserted into the tunnel to block it and help it heal. This is a less invasive option but may not be suitable for all types of complex fistulas.

5. VAAFT (Video-Assisted Treatment)

A small camera is used to see the fistula tunnel and treat it from the inside using special tools. This is a minimally invasive method.

What to Expect After Surgery

• You may go home the same day or after a short hospital stay, depending on the procedure.

• Some pain or discomfort is normal for a few days.

• You’ll need to keep the area clean and may be given stool softeners to prevent straining.

• Most people can return to normal activities in a few weeks, but healing can take longer in complex cases.

Will It Work?

Surgery is often successful, but complex fistulas may need more than one operation to fully heal. In most cases, the goal is to heal the fistula while protecting your ability to control bowel movements.

Important Notes

• You’ll be monitored for healing, and your doctor will check for signs of infection or recurrence.

• If you have a condition like Crohn’s disease, your treatment may also involve a specialist and long-term medication.

• Good hygiene, a fiber-rich diet, and following your surgeon’s instructions will support your recovery.