If the fistula passes through an important part between the anal sphincter muscles, the surgeon may first recommend that a surgical suture be inserted into the fistula.

The column is a piece of surgical thread that remains in the fistula for several weeks so that this infectious path is not closed and treated.

It is true that part of the sphincter is not cut in the column method, but the patient has to go to the doctor every few weeks to pull out a few centimeters of the thread, which is very painful.

For this reason, the threads drain the fistula, but they do not have much role in its treatment. Therefore, the surgeon or doctor you see may suggest you to perform the column along with the fistulotomy.
Advancement flap procedure

If the fistula passes through the anal sphincter muscles and performing a fistulotomy poses a high risk of incontinence, an advanced flap procedure may be considered.

This involves cutting or shaving the fistula and covering the opening where it enters the intestine with a piece of tissue taken from the inside of the rectum, which is the final part of the intestine.

It has a lower success rate than fistulotomy, but avoids cutting the anal sphincter muscles.
Advanced flap photo or advancement
Fistula surgery by biological plug or bioprosthesis method

Another treatment option is the insertion of a bio-prosthetic plug or a biological plug. This plug is a cone-shaped plug made of intestinal tissue and used to close the internal opening of the fistula. This tissue is attached to the external opening of the fistula and simulates the tissue inside the body.

This method has been reported to work well for anal fistula occlusion up to 80% of the time, and there are no serious safety concerns. But one of its disadvantages is that you have to stay in the hospital for 24 hours.
fibrin glue

Currently, apart from laser; Treatment with fibrin glue is the only option to treat fistula without surgery. During fibrin glue surgery, the patient is under general anesthesia and the doctor injects the glue into the fistula. The glue helps to seal the fistula and repair it.

In general, it is less effective than fistulotomy for simple fistulas, and the effectiveness of this method is usually not long-term, but it may be a useful option for fistulas that pass through the anal sphincter muscles because this method does not require an incision.
Care after anal fistula laser

All the methods we have introduced for treatment are effective provided that the patient tries to recover and performs the post-operative care well. You can help speed up your recovery by following these tips:

Drink enough water to prevent constipation
Adequate fiber intake and proper diet
Having physical activity and light sports for 30 minutes a day
Taking painkillers, antibiotics and medicines prescribed by the doctor at a certain time
Changing dressings regularly with the right method
Observing anal hygiene and not using scented or essential oil detergents
Refrain from having sex from behind
Reduce smoking and stop drinking alcohol
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