How do you fix a fistula in your rectum?

Fistulas that don’t heal or block may need surgery. The type of surgery will depend on where your fistula is located. Here are some:

- Fistulotomy: This is a simple procedure where the surgeon cuts open or "lays open" the fistula tract during local or general anesthesia, allowing it to heal from the bottom upward.

- Fistulectomy: This procedure involves removing the entire fistulous tract and possibly also the internal opening of the fistula inside your rectum. The wound may be left to heal on its own (healing by secondary intention) or repaired directly (healing by primary intention). Fistulectomy is more likely to be successful than fistulotomy. But this procedure works best if your fistula doesn't affect your anal sphincter muscle.

- Lift flap: This operation is recommended for patients who have fistulas that affect or run through part of your anal sphincter. The surgeon removes all or part of the diseased tissue including the fistula, but preserves the involved sphincter muscle.

- Muscle advancement flap: This procedure also recommended for people who have fistulas involving the sphincter muscle. Your surgeon separates the anal sphincter muscle from the tissue above the rectum. The healthy tissue is then brought down over the top of the fistula and sutured in place, covering the opening, and promoting the sealing and eventual healing of the fistula.

- Suture ligation of the Intersphincteric fistula tract (SLIFT): This procedure is reserved for specific types of fistulas.

A thin, elastic string (silk or nylon) is passed along the fistula tract and is brought out at the external opening of the fistula. Each end is then tied together, ligating (tying) the tract closed while preserving the overlying anal sphincter complex.