Complex Anal Fistula: A Distressing Condition That Affects Quality of Life

While most patients with anal fistulas can be cured with a single surgery, approximately 20% of patients may develop complex anal fistulas (recurrent anal fistulas), a challenging condition that requires specialized treatment. Effective diagnosis and treatment for complex fistulas require an experienced colorectal surgeon, as this increases the chance of full recovery.
 

What is a Complex Anal Fistula?

• Recurrent fistulas that persist despite multiple surgeries.

• Fistulas with multiple openings.

• Fistulas with an abscess cavity connected to the tract.

• Fistulas that penetrate through the sphincter muscle before emerging on the skin at a distance from the anal opening (transphincteric fistula) or travel above the external sphincter muscle and emerge on the skin away from the anus (suprasphincteric fistula). There are also fistulas that reach the external sphincter muscle and open into the lower rectum (extrasphincteric fistula).

Risks of Untreated Complex Fistulas

Though fistulas do not generally lead to severe diseases, they can cause discomfort due to continuous pus or discharge, leading to a wet, odorous area around the anus. In some cases, untreated fistulas may spread to other organs. Long-term complex anal fistulas, present for decades, may develop into cancer within the fistula cavity. Patients with weakened immune systems or coexisting conditions, such as diabetes, HIV, or cirrhosis, are at risk of severe infections that can lead to tissue death (Fournier’s gangrene).
 

How Are Complex Anal Fistulas Diagnosed?

Accurate diagnosis is crucial for treating complex fistulas. Doctors will take a thorough history and perform a detailed physical examination, often supported by an MRI scan or specialized ultrasound of the anal area. The goal is to identify the cause of the recurrent fistula, analyze the anatomy of the fistula, and assess complications related to bowel control, which helps the surgeon plan the best surgical approach.
 

Treatment for Complex Anal Fistulas

There is no single, standardized technique for treating complex fistulas. Doctors choose the most appropriate method based on each patient’s condition, selecting techniques with the highest likelihood of success while preserving or minimally affecting the sphincter muscle. This personalized approach aims to cure the patient without compromising bowel control.
 

Postoperative Care

Following surgery, regardless of the technique, patients usually stay in the hospital for just one night. Wound care is generally unnecessary, and patients can have a bowel movement on the first day. Recovery at home typically takes 4–5 days, after which patients can resume work and daily activities.

The Colorectal Surgery Center at Bumrungrad International Hospital has a team of specialized colorectal surgeons equipped to diagnose and treat complex fistulas with a tailored approach for each patient, maximizing the chances of a full recovery.