Anal Fistula Surgery in Ankara, Turkey

Anal fistula surgery aims to surgically remove abnormal tracts formed around the anus as a result of infection and inflammation. This condition usually develops after abscesses, and when it becomes chronic, surgery is the definitive treatment.

In anal fistula surgery, the fistula tract may be excised or a seton technique may be used. The choice of technique is determined by the location of the fistula and its proximity to the sphincter muscles. The goal is both to achieve healing and to preserve muscle function.

Wound hygiene is very important in postoperative care. Regular dressing changes, sitz baths, and a fiber-rich diet support the process. Patients can return to normal life within a few days, but full healing may take several weeks.

The success rate after anal fistula surgery is high. The risk of recurrence depends on the structure of the fistula. A specialist surgical approach both accelerates recovery and reduces the risk of possible complications.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Anal Fistula Surgery in Ankara, to get information about Anal Fistula Surgery prices, the process, and the hospital where Anal Fistula Surgery is performed.

What Is an Anal Fistula?

An anal fistula is an abnormal tract that forms between the skin around the anus and the rectum or the inner part of the anus. It usually develops after a perianal abscess (a pus-filled cavity). This condition manifests with symptoms such as persistent discharge, itching, foul odor, and intermittent pain.

What Are the Symptoms of an Anal Fistula?

An anal fistula is the formation of an abnormal tract between the anus and the surrounding skin, and it usually develops after prior abscesses. Since it is associated with infection, it presents with bothersome symptoms. Common anal fistula symptoms include:

• Continuous or intermittent discharge around the anus (purulent or bloody)
• Swelling, tenderness, and redness around the anus
• Itching, irritation, or foul odor in the anal area
• Pain during or after defecation
• Recurrent anal abscesses from time to time
• Fever and fatigue (if the infection is active)

These symptoms may indicate the presence of a fistula, and a proctological evaluation is required for a definitive diagnosis. Treatment is mostly surgical.

What Is Anal Fistula Surgery?

We can think of anal fistula surgery as the art of closing an unwanted “tunnel” opened in a very sensitive area of the body. This condition often appears as a bad memory of a previous abscess in that region. After an abscess, that is, a pus-filled swelling, drains or is drained, it may leave behind a thin tract. This tract is what we call a fistula.

The most frustrating aspect of this condition is that it becomes chronic. In other words, once it forms, it becomes a problem that the body cannot repair on its own. Medications such as antibiotics may suppress the active infection, reduce fever, and perhaps decrease discharge for a while, but they can never close the physical tunnel. As long as this tunnel remains, discharge that soils underwear, foul odor, pain, and worst of all, repeated abscess formation in the same area can turn the patient’s life into a nightmare. Therefore, the only definitive and permanent solution for an anal fistula is surgery.

However, there is a very important detail that distinguishes this surgery from others. The anal region has an extremely sophisticated muscle system (the sphincter muscles) that provides gas and stool control. The fistula tract also usually passes between or through these muscles. Therefore, the surgeon faces two important, seemingly conflicting tasks. The first is to eliminate the fistula tract completely so that it will not recur. The second is to do this without causing even the slightest damage to the muscles, meaning preserving the patient’s gas and stool control function 100%.

Establishing this balance forms the basis of anal fistula surgery. A successful operation not only heals the fistula but also enables the patient to return to normal life without any loss of function after surgery. For this reason, each patient’s fistula is unique like a fingerprint, and the surgical technique to be applied must be selected with great care on an individualized basis.

In Which Situations Is Anal Fistula Surgery Performed?

An anal fistula is a condition that usually makes itself known with quite clear and bothersome symptoms. Patients most often consult a doctor with the feeling that “something is not right in my anus,” due to long-standing complaints that do not go away. These typical symptoms that bring surgery into consideration include:

• Continuous or intermittent purulent discharge
• Foul odor accompanying the discharge
• Ongoing soiling and staining in underwear
• A small pimple-like opening at the edge of the anus from which discharge comes
• Recurrent, painful, red swellings (abscesses) in the same area
• A stinging, fullness, or aching type of pain felt especially while sitting
• Bleeding during defecation

These complaints negatively affect both the person’s physical health and social life. The constant need to use pads, hygiene concerns, and recurring painful abscesses seriously reduce quality of life and push the patient to seek a surgical solution.

What Are the Risks of Anal Fistula Surgery?

As with any surgical intervention, anal fistula surgery carries potential risks. Being open and honest about this is very important both for the patient to manage expectations correctly and to participate more consciously in the treatment process. The most important risk concerns gas and stool control.

The most feared and most emphasized risk of this surgery is incontinence, meaning the inability to control gas or stool. Since the fistula tract passes through the muscles that provide this control, there is a possibility that these muscles may be damaged to some extent during surgery. This risk is more pronounced especially with older, more aggressive methods or when the fistula is very complex. The main goal in modern surgery is to reduce this risk to zero. For this reason, sphincter-sparing techniques have been developed. Although postoperative problems are usually mild (such as gas leakage or mild soiling in underwear), more serious control losses may rarely occur. The surgeon’s experience and choosing the right technique are the most important factors minimizing this risk.

There are also other possible risks and complications.

• Recurrence of the fistula
• Delayed wound healing
• Bleeding
• Infection and abscess formation
• Anal stenosis

Recurrence of the fistula is the most common long-term problem. The disease may reappear after a while due to reasons such as a hidden branch being missed or the internal opening not being fully closed. Delayed wound healing may occur especially after fistulotomy surgery where an open wound is left and requires patience. As with any surgery, there are risks of bleeding and infection, but these can usually be controlled. Very rarely, anal stenosis may develop as a result of healing tissue narrowing the anal canal. All of these risks can be reduced to the lowest level with appropriate surgical technique and good postoperative care.

How Is Anal Fistula Surgery Performed?

The first and most important step to success in anal fistula surgery is accurate diagnosis and flawless surgical planning. It is not enough to identify the presence of the fistula; it is necessary to understand its character—its course, its relationship with the muscles, and any possible hidden extensions. This process resembles a detective putting together clues and consists of several stages.

The main steps followed for preoperative diagnosis and planning are:

• Careful physical examination
• Examination under anesthesia (EUA)
• Pelvic MRI (Magnetic Resonance Imaging)
• Endoanal Ultrasound (EAUS)

Each of these steps completes a different part of the puzzle. Physical examination usually provides the initial diagnosis. The doctor forms a preliminary impression by seeing the small external opening around the anus and feeling the fistula tract during a digital examination.

However, most of the time—especially if the fistula appears complex—the clearest information comes from an examination under anesthesia. During this procedure, the patient is put under light anesthesia and feels no pain. This allows the surgeon to examine the area comfortably and map the tract by following the tunnel with a thin probe. In simple fistulas, diagnosis can be made during this examination and treatment (surgery) can be performed at the same time.

If a complex situation is suspected—such as recurrence of the fistula, multiple tunnels, or deep extension into the muscles—advanced imaging methods come into play. Pelvic MRI is the gold standard in this regard. Without exposing the body to radiation, it provides an almost three-dimensional map of the region. With over 90% accuracy, it shows where the fistula starts and ends, how much of the muscles it involves, and whether there is a hidden abscess or an unrecognized secondary branch. It functions like a roadmap that prevents surprises during surgery and helps preserve the muscles. Sometimes endoanal ultrasound can also be used to visualize the muscle structure in detail. When all these data are combined, the most appropriate surgical method for the patient is determined.

So, are all anal fistula surgeries the same—what are the methods? Absolutely not. Just as every person’s fingerprint is different, each fistula’s anatomy is different. Therefore, there is no “one size fits all” approach in anal fistula surgery. The surgical method is determined entirely by the fistula’s relationship with the anal muscles—that is, whether it is “simple” or “complex.”

The basic method for simple fistulas is fistulotomy. These fistulas pass through a very superficial portion of the muscles or have no relationship with the muscles at all. Fistulotomy involves cutting the skin and a very small amount of muscle fibers over the tunnel, turning the tract into an “open groove.” This open wound heals slowly from the bottom upward. When applied to the appropriate patient group, the success rate is over 95%, and the risk of gas-stool leakage is extremely low.

Complex fistulas are where the work becomes more challenging. These fistulas pass through a significant portion of the muscles. Performing fistulotomy in such patients can cause permanent muscle damage and lead to serious gas-stool leakage problems. Therefore, the basic principle in these fistulas is treating the fistula without touching the muscles or by touching them minimally. Modern “sphincter-sparing” methods have been developed for this purpose.

The main surgical techniques used in complex fistulas are:

• Seton placement (for drainage)
• LIFT technique
• Flap (patch) procedures
• Laser fistula closure (FiLaC)
• VAAFT (Video-assisted treatment)

Seton placement is usually the first step in the treatment of complex fistulas. A silk thread or thin rubber loop is passed through the fistula tract, allowing continuous drainage of the infection inside and preventing abscess formation. This is not a definitive treatment but a method to calm the area and prepare it for the main surgery.

The LIFT technique is based on entering through the natural space between the two anal muscles, identifying the fistula, and ligating and dividing it from within. Since it does not involve the main muscles responsible for bowel control, it is an extremely safe method.

Flap (patch) procedures involve closing the internal opening of the fistula inside the bowel with a piece of tissue taken from the healthy bowel wall. Like patching a hole, the source of the fistula is eliminated.

Minimally invasive methods such as laser (FiLaC) and VAAFT are popular technologies of recent years. In the laser method, a fiber probe inserted into the tunnel closes the tract by ablating it from the inside. In the VAAFT method, a very thin camera is inserted into the tunnel for visualization, the tract is cleaned from the inside, and the internal opening is closed. Both methods do not damage the muscles, cause less postoperative pain, and provide a more comfortable healing process. The surgeon will carefully choose the most suitable technique among these options based on the patient’s condition.

Postoperative Process After Anal Fistula Surgery

The period after anal fistula surgery is at least as critical as the surgery itself for the success of treatment. During this period, the patient’s patience and strict adherence to the doctor’s recommendations both speed up healing and prevent possible problems. Although the healing process varies from person to person and depending on the type of surgery performed, what to pay attention to is generally similar.

Some important steps that will increase your postoperative comfort and help your recovery include:

• Using prescribed painkillers regularly
• Taking warm sitz baths several times a day
• Drinking at least 2–2.5 liters of water per day
• Paying attention to a fiber-rich diet
• Not neglecting stool softeners prescribed by the doctor
• Cleaning the area gently with water after using the toilet
• Taking light-paced walks in the first weeks
• Avoiding heavy lifting and strenuous exercise

One of the most important elements of this process is pain control. Especially the first bowel movement can be quite painful. To make it easier, it may be helpful to use painkillers regularly and take a dose about half an hour before defecation. However, the most effective way to reduce pain and relax the area is warm sitz baths. These baths both relax the muscles and keep the area clean.

Preventing constipation is vital. Hard stool not only causes unbearable pain but can also damage stitches or sensitive tissues in the surgical area. Therefore, drinking plenty of water, consuming fiber-rich foods, and using stool softeners prescribed by the doctor are essential.

Regarding wound care, it is usually sufficient to keep the area clean and dry. Mild discharge from the wound for several weeks is normal and part of healing. Not missing follow-up appointments scheduled by your doctor is very important to ensure the wound is healing properly from the base to the surface.

What Should Patients Pay Attention to After Anal Fistula Surgery?

The surgery is over, the wounds have healed, and you have taken a comfortable breath. So what now? To ensure that the comfort achieved after anal fistula surgery is lasting and to minimize the risk of recurrence, it is very important to adopt certain lifestyle habits. These habits are beneficial not only for anal health but also for overall health.

For long-term protection of your health, there are things you should pay attention to:

• Making a high-fiber diet a lasting habit
• Never neglecting adequate water intake
• Not sitting on the toilet for a long time and not straining
• Always paying attention to local hygiene

A healthy digestive system reduces pressure in the anal region. Therefore, a diet rich in vegetables, fruits, and whole grains ensures that stool is always soft. Drinking at least 2 liters of water a day is the most important complement to this diet. Not postponing the urge to use the toilet and not spending long periods on the toilet with a phone or book are also good habits to adopt.

In addition, you should learn to listen to your body. Even after the surgical area has fully healed, certain warning signs should be taken seriously. If you experience any of the following, you should contact the surgeon who performed your operation rather than saying, “I’ll wait a bit, it will pass.”

Warning signs that require contacting your doctor include:

• New discharge starting from a previously healed area
• Recurrent pain, tenderness, or swelling at or near the surgical site
• Fever or a general feeling of fatigue accompanying local complaints