Fistula Correction/Repair in Illinois

The GI specialists at GI Alliance of Illinois will diagnose a fistula by reviewing your medical history and performing a physical exam. A digital rectal exam (the insertion of a gloved finger through the anal cavity) will allow the gastroenterologist to locate the internal opening of the fistula, and make observations on the sphincter muscles and any branching they may notice. The provider may use other instruments including a fistula probe or a proctoscope to further examine the rectum. In the event of complicated branching or to find the exact positioning of the fistula channels, a provider may request for an ultrasound, MRI scan, or a CT to be performed. If you believe you might need treatment for a possible fistula, please contact a GI Alliance of Illinois provider near you to request a consultation.

Anal fistulae vary in size and complexity. Some will only have one opening, while others will branch out with many openings. Due to the proximity to the anus, some fistulae may be connected to the sphincter muscles that control the opening and closing of the anus. Although anal fistulae are often treated through surgery, fistula repair may be first attempted with fibrin glue. This nonsurgical option involves injecting fibrin glue into the opening of the fistula and closing it with stitches. If fibrin glue does not resolve the symptoms of the fistula, surgery will be required. Our GI providers will give you instructions on how to best prepare for your surgical procedure and will recommend that you stop smoking and also fast for 6 hours prior to surgery. To empty your lower bowels, you will be given an enema approximately an hour before the surgery begins. During the anal fistula procedure, you will be placed under general anesthesia to ensure your comfort. There are different types of fistula repairs that your provider may choose depending on the position and complexity of your fistula including:

• Bioprosthetic plug: A cone-shaped plug, made from human tissue, is placed to partially block the internal opening of the fistula and held with a suture allowing for drainage.
• Fistulotomy: the fistula is cut open length-wise to flush out the contents and heals after 1 – 2 months into a flattened scar.
• Advancement flap procedures: Entire fistula tract is removed and tissue is attached over the opening of the fistula. An advancement flap is made from tissue that is removed from the rectum or skin surrounding the anus. Preferred for patients at high risk for incontinence or those having complex fistulas.
• Seton technique: a surgical thread is passed through the fistula and left in place for an extended amount of time (months) or permanently, keeping the fistula tract open and allowing the contents of the tract to drain. Considered for patients whose fistulas interfere with the sphincter muscles and are at risk for incontinence.

It is imperative to discuss any questions or concerns you have regarding fistula repair options with your GI Alliance of Illinois provider to determine the best course of action for the treatment of your fistula.