An anal fistula is an abnormal tunnel connecting the anal canal with the skin in your buttock beside the anus. It usually arises from an infection of an anal gland that burst into your buttock skin. If someone has an anal abscess, antibiotics may help to prevent it from becoming an anal fistula. However, once an anal fistula is formed, surgery will be required to cure the patient.
There are many surgical techniques available and an overview can be found in the link below [1]. The aim of surgery is to remove the infection but maintain anal continence at the same time while trying to cure the patient. I usually discuss all the various options of treatment with the patient and explain the process, success rate and complication rate of each approach. That is individualised to each patient as the fistula tract can be different between patients.
In my experience, about 90% of anal fistulas are the simple types which can be treated with a single surgery and has a low risk of recurrence and negligible risk of anal incontinence. I tend to use a combination of different surgical techniques for complex fistula as each surgical technique has its strength and weakness. The surgeon must have a good grasp of all the techniques to find the best solution for each patient. In my experience, patients with complex fistulas can be cured but may need more than one surgery or longer time for recovery.
References:
1. Dr Lim Jit Fong. Perianal abscess and Anal Fistula, Singapore - Lim Jit Fong Colorectal Centre. Colorectal-surgery.com.sg. http://www.colorectal-surgery.com.sg/medi_page/site_web_ljf/common_page.asp?pg=12. Published 2011. Accessed January 17, 2020.
