Advanced sphincter-preserving surgical treatment for all types of anal fistula — including Fistulotomy, LIFT, VAAFT, Laser Fistula Closure, and Seton placement. Performed by Dr. Hamikchandra Patel at Shaleen Multi Speciality Hospital, Sola. Minimal recurrence. Fast recovery. Confidential care.
Understanding Anal Fistula
An anal fistula is an abnormal tunnel or channel that forms between the inside of the anal canal and the skin around the anus. It is almost always the result of a previous anal abscess that either burst spontaneously or was surgically drained but left an unhealed tract behind. The tract becomes lined with tissue, preventing it from closing on its own.
Unlike piles or fissures, an anal fistula never heals without treatment. The internal opening (inside the anal canal) continuously allows bacteria and bowel contents to enter the tract — causing repeated infection, pus discharge, and discomfort. Surgery is the only effective cure for an anal fistula.
The surgical challenge lies in eliminating the fistula while protecting the sphincter muscles that control bowel continence. Dr. Hamikchandra Patel is experienced in the full spectrum of sphincter-preserving techniques — from simple fistulotomy to advanced VAAFT — ensuring the most appropriate procedure is chosen for each patient's anatomy and fistula complexity.
Most anal fistulas originate from cryptoglandular infection — infection of small glands in the anal canal. These glands become blocked, an abscess forms, and when it drains, it may leave a persistent tract — the fistula. The internal opening is typically at the level of these glands and the external opening is on the perianal skin.
An anal abscess is the acute infection phase — a painful collection of pus requiring urgent drainage. An anal fistula is the chronic phase — the tunnel that remains. About 50% of anal abscesses eventually form a fistula.
Fistulas associated with Crohn's disease, tuberculosis, radiation, or malignancy require specialised evaluation before surgery. Multiple fistula tracts, poor healing, or unusual locations may be red flags requiring further investigation.
Classification
Anal fistulas are classified by the relationship of the tract to the sphincter muscles. This guides the choice of surgical technique — because the higher the fistula, the greater the risk to continence and the more complex the surgery.
The most common type (70% of cases). The tract passes through only the internal sphincter and runs between the two sphincter muscles to open on the perianal skin. Low-lying and relatively straightforward to treat.
Low ComplexityThe tract crosses through both internal and external sphincter muscles at a variable height. Low transsphincteric fistulas can be managed with fistulotomy; high ones require sphincter-sparing techniques.
Moderate ComplexityThe tract passes above the entire sphincter complex and then curves downward between the sphincter muscles to reach the skin. These are complex fistulas that require advanced sphincter-preserving techniques like LIFT or VAAFT.
High ComplexityThe rarest and most complex type. The tract bypasses the sphincter muscles entirely and communicates with the rectum above the sphincter complex. Often associated with Crohn's disease or pelvic pathology. Requires specialised management.
Very ComplexThe tract extends around the circumference of the anal canal, with a posterior midline internal opening and bilateral external openings — forming a horseshoe shape. Often requires staged surgery with seton placement followed by definitive repair.
High ComplexityFistulas that have returned after previous surgery, or those associated with Crohn's disease, require a different approach — often long-term seton drainage, biologic therapy, or advanced minimally invasive techniques like VAAFT or LIFT.
SpecialisedRecognise the Signs
Anal fistula symptoms are often persistent and progressive. Early diagnosis and appropriate surgical treatment prevents complications like recurrent abscesses, complex tract extension, and sphincter involvement.
The hallmark symptom of an anal fistula — a constant or intermittent discharge of pus, blood-stained fluid, or faecal matter from a small opening near the anus. The discharge may soil underwear and cause skin irritation.
Throbbing or constant pain around the anus, which may worsen during sitting, walking, or bowel movements. Swelling or redness may be visible at the external opening of the fistula on the perianal skin.
Repeated episodes of painful pus collections near the anus — each requiring drainage — are a classic presentation of an underlying fistula. If abscesses keep returning, an anal fistula is almost certainly present and requires surgical treatment.
Constant moisture and discharge from the fistula opening irritates the surrounding skin, causing persistent itching, redness, and dermatitis around the anus. This is often the most socially disruptive symptom of an anal fistula.
Bright red blood may be noticed at the fistula's external opening or on toilet tissue. While not usually heavy, bleeding from a fistula tract should always be evaluated by a specialist to exclude associated conditions.
When the fistula tract becomes acutely infected and re-abscesses, patients may develop fever, chills, and general unwellness. This indicates active sepsis and requires prompt medical attention — sometimes emergency surgical drainage.
Surgical Techniques
Dr. Hamikchandra Patel offers all six major surgical techniques for anal fistula — from conventional fistulotomy for simple tracts to the most advanced sphincter-preserving procedures for complex fistulas. The optimal technique is selected after detailed pre-operative assessment including MRI fistulogram when necessary.
The entire fistula tract is laid open (cut) along its length and left to heal from the inside out. The most effective technique for simple, low-lying fistulas that do not involve significant sphincter muscle.
The entire fistula tract is surgically excised (removed) rather than laid open. Results in a clean wound that heals from the base upward. Preferred when the tract is isolated, well-defined, or when associated with granulation tissue or skin tags.
The fistula tract is identified and ligated (tied off) in the intersphincteric space between the two sphincter muscles — without cutting through the sphincter itself. The ideal choice for high transsphincteric fistulas where fistulotomy would risk incontinence.
A laser fibre is inserted into the fistula tract and delivers radial laser energy to ablate and close the entire tract from the inside without any external incision. The internal opening is then closed with sutures. Minimal pain, no external wound, and very fast recovery.
The most technologically advanced sphincter-preserving technique. A small video endoscope (fistuloscope) is passed through the external opening of the fistula, allowing the surgeon to visualise the entire tract under direct vision. The tract is then ablated from the inside and the internal opening closed.
A seton is a thread or silastic loop passed through the fistula tract and tied loosely (loose seton) or tightened gradually (cutting seton). Used as a staged approach — to control infection and fibrose the tract before definitive surgery, or as long-term palliation in Crohn's-related fistulas.
Procedure Comparison
The choice of fistula surgery depends on the type of fistula, how much sphincter is involved, whether it is a first-time or recurrent fistula, and the patient's individual health profile. Here is a quick comparison guide:
| Procedure | Best For | Sphincter Risk | Hospital Stay | Cure Rate |
|---|---|---|---|---|
| Fistulotomy | Simple, low fistulas | Very Low | 24 Hours | 95%+ |
| Fistulectomy | Isolated low–moderate fistulas | Low | 24 Hours | 90%+ |
| LIFT | High transsphincteric fistulas | None | 24 Hours | 80–90% |
| Laser (FiLaC) | Simple to complex fistulas | None | 24 Hours | 70–85% |
| VAAFT | Complex, recurrent, high fistulas | None | 24 Hours | 75–85% |
| Seton | Staged / Crohn's / Horseshoe | None | 24 Hours | Stage 1 of Treatment |
Step-by-Step Process
Dr. Hamikchandra Patel takes a thorough history and performs clinical examination to assess the fistula's external opening(s), probe the tract gently, and evaluate sphincter tone. Associated conditions like piles, fissure, or skin tags are noted for simultaneous treatment planning.
For complex, recurrent, or high fistulas, an MRI fistulogram is arranged to precisely map the fistula tract, identify secondary tracks and collections, assess sphincter involvement, and guide the safest surgical approach. This crucial step prevents failed surgery and continence complications.
Routine blood tests, fasting, a small bowel preparation enema, and medication review are arranged. Most fistula surgeries are elective and planned procedures — you will be given a clear pre-op checklist. Antibiotics are administered before surgery to reduce infection risk.
Under spinal or general anaesthesia, the selected technique (Fistulotomy, LIFT, VAAFT, or Laser) is performed. Duration ranges from 30–90 minutes depending on complexity. For VAAFT, a fistuloscope is used to visualise and ablate the tract under direct vision. The procedure is meticulously performed to preserve sphincter integrity while ensuring complete fistula eradication.
Patients are monitored post-operatively and discharged within 24 hours once stable and comfortable. Detailed wound care instructions, diet guidelines, sitz bath routine, prescribed medications, and warning signs to watch for are provided before discharge.
For fistulotomy: the open wound heals from the inside out over 4–10 weeks with regular dressings and sitz baths. For LIFT, VAAFT, and Laser: no external wound — faster recovery with return to work in 3–7 days. Follow-up visits at 1 week and 4 weeks confirm healing and assess for recurrence.
Treatment Cost
The cost of fistula surgery in Ahmedabad depends on the complexity of the fistula, the surgical technique selected, investigation costs (MRI fistulogram), anaesthesia, hospital stay, and whether combined procedures are performed.
| Procedure | Fistula Type | Approx. Cost |
|---|---|---|
| Fistulotomy | Simple / Low | Call for Quote |
| Fistulectomy | Low–Moderate | Call for Quote |
| LIFT Surgery | High Transsphincteric | Call for Quote |
| Laser Fistula Closure (FiLaC) | Simple to Complex | Call for Quote |
| VAAFT | Complex / Recurrent | Call for Quote |
| Seton Placement | Staged / Crohn's | Call for Quote |
Several key factors determine the final cost of your fistula treatment in Ahmedabad:
Anal fistula surgery is covered under most health insurance policies in India. Our team assists with cashless claims, pre-authorisation, and all insurance paperwork.
📞 Get Cost EstimateWhy Choose Us
From simple fistulotomy to advanced VAAFT — Dr. Hamikchandra Patel is trained and experienced in all six surgical approaches, ensuring the best-fit technique for every patient's unique anatomy.
We offer the most advanced sphincter-preserving techniques including VAAFT (video-assisted) and Laser Fistula Closure (FiLaC) — ensuring complex fistulas are treated without any risk to bowel continence.
Complex and recurrent fistulas are mapped with high-resolution MRI fistulogram before surgery — ensuring no secondary tracts are missed and the safest surgical plan is selected for each case.
Anorectal conditions carry a social stigma that prevents many patients from seeking timely help. At Dr. Gastro, every patient is treated with complete privacy, compassion, and professionalism — no judgement.
Anal fistula surgery is covered under most Indian health insurance policies. We facilitate cashless admissions, pre-authorisation, and complete insurance claim support to ease the financial aspect of your treatment.
Fistula, piles, fissure, and skin tags can all be treated in a single surgical session when coexisting — minimising hospital admissions, total recovery time, and overall treatment cost.
Post-Surgery Guidance
Most patients recover smoothly after fistula surgery. However, contact your surgeon promptly if you experience any of the following during recovery:
Frequently Asked Questions
Don't suffer in silence. Anal fistula is a treatable condition — with the right surgery, you can achieve permanent relief and return to a pain-free, comfortable life. Book a confidential consultation with Dr. Hamikchandra Patel at Shaleen Multi Speciality Hospital, Sola, Ahmedabad.
Welcome to the premier clinic for the Best fistula surgery in Ahmedabad, where we specialize in comprehensive treatment options for patients suffering from fistulas. Our advanced surgical techniques provide effective relief and faster recovery, ensuring high-quality care tailored to your needs.
Treatment Section
At our clinic, we provide the Best fistula surgery in Ahmedabad, employing a range of advanced techniques such as Fistulotomy, Fistulectomy, and innovative laser treatments to ensure optimal outcomes for our patients.
Pus Discharge from the Perianal Region:
Primary Cause – Cryptogenic Anal Gland Abscess:
Secondary Causes – Underlying Conditions:
Need for Medical Attention:
Treatment and Management at Our Clinic:
