Fistulotomy
The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.
A fistulotomy is the most effective treatment for many anal fistulas, although it’s usually only suitable for fistulas that do not pass through much of the sphincter muscles, as the risk of incontinence is lowest in these cases.
If the surgeon has to cut a small portion of anal sphincter muscle during the procedure, they’ll make every attempt to reduce the risk of incontinence.
In cases where the risk of incontinence is considered too high, another procedure may be recommended instead.
Endoscopic ablation
In this procedure, an endoscope (a tube with a camera on the end) is put in the fistula.
An electrode is then passed through the endoscope and used to seal the fistula.
Endoscopic ablation works well and there are no serious concerns about its safety.
Laser surgery
Radially emitting laser fibre treatment involves using a small laser beam to seal the fistula.
There are uncertainties around how well it works, but there are no major safety concerns.
