Dr Ho Kok Sun
Consultant Colorectal & General Surgeon
MBBS (Singapore), M Med (General Surgery) (Singapore)
FRCS (General Surgery) (Edinburgh), FAM (Singapore)
Being told you need anal fistula surgery can understandably feel daunting. You may be wondering whether surgery is your only option, what the procedure involves and how long it will take before you can return to your normal routine.
The reassuring news is that there are several established approaches to anal fistula repair, and treatment is tailored to the type of fistula you have rather than following a one-size-fits-all approach. Understanding how surgery is planned and what recovery typically involves can help you feel better prepared for the treatment journey ahead.
Why Is Surgery Usually Needed?
An anal fistula is an abnormal tunnel that develops between the anal canal and the skin around the anus. It often forms after an anal abscess has drained or been treated but does not heal completely. Unlike an abscess, an anal fistula rarely heals on its own because the tunnel remains in place. Without treatment, symptoms such as persistent discharge, pain, swelling or recurrent infections may continue.
For most patients, anal fistula treatment is recommended to remove or close the abnormal tract, clear ongoing infection and reduce the risk of recurrence.
What Surgical Options Are Available for Anal Fistulas?
Most anal fistula surgery is performed under general anaesthesia and can usually be carried out as day surgery. Patients with more complex fistulas or ongoing infection may occasionally require a short hospital stay or overnight observation.
The surgical technique used depends on the fistula's anatomy and the amount of anal sphincter muscle involved.
Fistulotomy
Fistulotomy is the most common procedure for simple anal fistulas that involve only a small portion of the sphincter muscles. During the procedure, the surgeon opens the fistula tract along its entire length so it can heal gradually from the inside out. Because only a small amount of muscle is divided, this technique generally has high success rates while carrying a low risk of affecting bowel control.
However, fistulotomy is not suitable for deeper or more complex fistulas, where dividing additional sphincter muscle could increase the risk of incontinence.
Seton Placement
A seton is a soft surgical thread placed through the fistula tract to allow continuous drainage while protecting the anal sphincter muscles.
This technique helps control infection and encourages gradual healing. In some cases, the seton is used as the first stage of treatment before a second procedure is performed to complete the repair once it is safe to do so.
Sphincter-Preserving Surgery
For fistulas involving a larger portion of the sphincter muscles, procedures that preserve these muscles may be recommended to reduce the risk of bowel incontinence.
One option is the LIFT (Ligation of Intersphincteric Fistula Tract) procedure, which closes the fistula tract between the sphincter muscles without dividing them. Another is the advancement flap procedure, where healthy tissue is used to cover the internal opening after it has been cleaned.
For selected patients, newer minimally invasive techniques such as Video-Assisted Anal Fistula Treatment (VAAFT) may also be considered. Other options, including fibrin glue and collagen plugs, may be suitable in certain cases, although these generally have lower success rates.
What Should You Expect After Surgery?
Recovery depends on the type of procedure performed and the complexity of the fistula. Most patients can return home on the same day, although more extensive surgery may require a short hospital stay. It is normal to experience mild discomfort, light bleeding or drainage from the wound after surgery. Pain is often most noticeable during bowel movements in the first few days but is usually manageable with medication.
To support healing and reduce the risk of complications, your surgeon will provide aftercare instructions, which may include:
- Warm sitz baths to keep the area clean
- Regular dressing changes or wound cleaning where needed
- Maintaining good hygiene after bowel movements
- Taking stool softeners if recommended
- Drinking plenty of fluids and eating sufficient fibre to avoid straining
Follow-up visits are an important part of recovery, as your surgeon may need to assess healing and clean the wound if necessary.
How Long Does Recovery Take?
Recovery time varies depending on the procedure performed and the complexity of the fistula. Many patients can return to light daily activities within a few days, although strenuous exercise and heavy lifting should be avoided until advised by your surgeon.
Complete healing may take several weeks or longer, particularly for larger or more complex fistulas. Following your aftercare instructions and attending follow-up appointments can support healing and help reduce the risk of recurrence.
What Are the Possible Risks?
Like any operation, anal fistula surgery carries potential risks, although serious complications are uncommon.
Possible risks include:
- Bleeding
- Infection
- Delayed wound healing
- Recurrence of the fistula
- Bowel incontinence if excessive sphincter muscle is divided
The likelihood of complications depends on factors such as the complexity of the fistula, the surgical technique used and how well the wound heals after surgery. Careful treatment planning aims to achieve complete healing while minimising these risks.
Moving Forward with the Right Treatment
Although surgery can seem intimidating at first, understanding what to expect often makes the process feel more manageable. With several techniques now available, anal fistula repair can be tailored to the characteristics of each fistula, helping achieve healing while protecting bowel function wherever possible.
At our anal fistula clinic in Singapore, treatment is provided under the care of Dr Ho Kok Sun, who offers comprehensive assessment and personalised treatment planning for anal fistulas. If you have persistent anal pain, discharge, recurrent abscesses or have been diagnosed with an anal fistula, schedule a consultation and discuss the most appropriate treatment approach for your condition.
Frequently Asked Questions (FAQs) About Anal Fistula Surgery
Why do some people need more than one operation?
Certain procedures, such as the seton technique, are designed to treat the fistula in stages to protect the anal sphincter muscles. A second procedure may be planned once it is safer to complete the repair.
Can an anal fistula return after successful surgery?
Recurrence is possible, particularly in complex fistulas. The risk depends on factors such as the fistula's anatomy, complete closure of the internal opening and postoperative wound healing.
Can I prevent another anal fistula from developing?
Not all anal fistulas can be prevented, especially those related to underlying bowel disease. However, seeking prompt treatment for anal abscesses and attending follow-up appointments may help reduce the risk of persistent infection and complications.
Meet Our Anal Fistula Surgeon in Singapore
Dr Ho Kok Sun is a Ministry of Health-accredited hernia surgeon in Singapore with over 15 years of experience. Dr Ho Kok Sun is a Ministry of Health-accredited colorectal and piles surgeon in Singapore with in-depth experience diagnosing and treating a wide range of colorectal conditions, including anal fistulas. He obtained his Master of Medicine in Surgery from the National University of Singapore in 1998 and became a Fellow of the Royal College of Surgeons of Edinburgh the same year. After completing his General Surgery training in 2002, he pursued a fellowship at the Cleveland Clinic Florida and has since sub-specialized in colorectal surgery.