Treatment methods

Anal fistula treatment

Our specialists have great experience in the treatment of anal fistula. They use modern surgical techniques to help you.

Surgical treatment methods

Surgical treatment methods

Basic goals of operative therapy are to open the anal fistula or abscess, ensure secretion drain and thereby eliminate pain. In some cases, the course of a fistula can be clarified during primary intervention with a bulb-headed probe. Definitive remediation during primary intervention only succeeds for very low anal fistulas. All other findings, in which a further measure could lead to an impairment of continence, are often first tended to during primary intervention or later with a so-called suture drainage (Seton technique). Undisturbed so, the surrounding reaction can subside until the strand drainage itself (usually a plastic rein) forms a connective tissue scar or fistula. 

Definitive therapy

In definitive therapy, the following surgical procedures adapted to the respective anatomical situation are used. The goal is always to remove the entire fistula tissue and damage the sphincter only as little as possible.

Fistulectomy (lay-open technique, splitting method) is reserved for very low fistulas. As a result, the fistula tissue and the muscles are split. At most the lower half of the inner sphincter should be affected. Relapse rates are below ten percent. Continence disorders are at best low and temporary.

Higher located anal fistulas are treated with two different surgical techniques:
Either they are removed by microsurgery, the inner fistula opening is sutured and covered with a local sliding flap from the rectal wall (flap technique). Immediate suture leakage occurs in up to ten percent of cases, with relapse rates between five and 30 percent. Discrete continence disorders can be expected in up to 40 percent, but higher grade ones only in isolated cases.
Alternatively, the sphincter muscles are severed via the fistula, the fistula tissue is completely removed and the muscles are primarily reconstructed.

Fistulas can in certain cases be closed with fibrin glue or a conical shaped implant made of natural tissue. The disadvantage here, however, is the high recurrence rate.

Special forms are rectal or anovaginal anal fistulas, i.e. fistulas between the rectum or the anal canal and the vagina. Due to their special anatomical position, plastic surgery procedures are usually required. Relapse rates are significantly higher.

Secondary fistulas in chronic inflammatory bowel disease (Crohn's disease, ulcerative colitis) are often complex fistula systems, which have a high rate of relapse and are therefore often tended to with suture drains.