Mucosal advancement flap: An advancement flap procedure may be considered if your fistula passes through the anal sphincter muscles and having a fistulotomy carries a high risk of causing incontinence.
This involves cutting or scraping out the fistula and covering the hole where it entered the bowel with a flap of tissue taken from inside the rectum, which is the final part of the bowel.
This has a lower success rate than a fistulotomy but avoids the need to cut the anal sphincter muscles.
Anal Fistula Plug (AFP): Another option is the insertion of a bioprosthetic plug.
This is a cone-shaped plug made from animal tissue that’s used to block the internal opening of the fistula.
This procedure works well for blocking an anal fistula and there are no serious concerns about its safety.
Seton Techniques: If your fistula passes through a significant portion of the anal sphincter muscle, the surgeon may initially recommend inserting a seton.
A seton is a piece of surgical thread that’s left in the fistula for several weeks to keep it open.
This allows it to drain and helps it heal while avoiding the need to cut the sphincter muscles.
Loose setons allow fistulas to drain but do not cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly.
This may require several procedures that the surgeon can discuss with you.
Or they may suggest carrying out several fistulotomy procedures, carefully opening up a small section of the fistula each time or a different treatment.