Anal Fistula Treatment (Laser, VAAFT & LIFT)
A fistula does not heal on its own — it needs the tract closed and the internal opening dealt with. Our proctologists use sphincter-sparing techniques such as laser closure, VAAFT and LIFT so the fistula is cured without putting your continence at risk. Daycare procedure, cashless insurance, no-cost EMI and a care coordinator with you from the first call to full healing.
- Cashless Insurance Support
- No-Cost EMI
- Free Pickup & Drop
- Dedicated Care Coordinator
- 24×7 Patient Support
- No Hidden Charges
Get Expert Surgical Guidance
Connect with our care team for treatment guidance.
What is Fistula?
An anal fistula — doctors call it fistula-in-ano — is an abnormal tunnel that connects the inside of the anal canal to the skin near the anus. It has two ends: an internal opening inside the anal canal, and one or more external openings on the skin outside, from which pus or blood-stained fluid keeps discharging.
Around nine out of ten fistulas begin as a perianal abscess. There are small glands inside the anal canal; when one of them gets blocked and infected, pus collects and forms an abscess. That abscess either bursts on its own or is drained surgically — and in a good number of patients, the track it carved out on its way to the skin never closes. What remains is the fistula.
This is the single most important thing to understand about a fistula: it does not heal on its own. A fissure can heal, piles can shrink, but a fistula is an epithelialised tunnel with a persistently infected internal opening feeding it. Antibiotics will settle a flare-up and dry the discharge for a while, but the tract remains, and the discharge returns. Definitive treatment means dealing with the internal opening and closing the tract — there is no medicine that does that.
Surgeons classify fistulas by how the tract relates to the anal sphincter muscles, using the Parks classification. Intersphincteric fistulas run between the two sphincter muscles and are the most common and the simplest. Transsphincteric ones cross through the external sphincter. Suprasphincteric and extrasphincteric fistulas are uncommon, take a longer course and are the most difficult to treat. In practice, surgeons talk about simple fistulas — low, single, straight — and complex ones that are high, branching, recurrent, in front of the anus in a woman, or associated with Crohn's disease.
That classification is not academic. It decides everything about your treatment, because the sphincter muscles are what give you control over stool. A low fistula can be safely laid open. A high one cannot — dividing that much muscle risks incontinence. This is exactly why sphincter-sparing techniques such as laser closure (FiLaC), VAAFT and LIFT exist, and why an MRI is often done before surgery rather than after.
Leaving a fistula untreated is not a neutral choice. It leads to repeated painful abscesses, additional side branches that make later surgery harder, constant soiling and skin irritation, and in rare, very long-standing cases, malignant change within the tract.
Treatment information
| Condition | Anal Fistula (Fistula-in-ano) |
|---|---|
| Procedure | Laser Fistula Closure / VAAFT / LIFT / Fistulotomy |
| Duration | 30 to 60 minutes |
| Treated by | Proctologist / General Surgeon |
| Anaesthesia | Spinal or short general anaesthesia |
| Success rate | 85–95%, depending on the type of fistula |
| Recovery time | 3 to 7 days back to routine; 4 to 6 weeks to heal fully |
| Hospital stay | Daycare — same-day discharge in most cases |
Signs you may need Fistula treatment
- Persistent discharge of pus, blood or foul-smelling fluid near the anus
- A small opening or boil-like lump on the skin around the anus
- Recurrent painful swelling that builds up, bursts and settles, then returns
- Throbbing pain that worsens on sitting, moving or passing stool
- Itching, irritation and excoriation of the surrounding skin
- Staining of undergarments that forces frequent changes or pads
- Fever and feeling unwell when the tract blocks and an abscess re-forms
What causes it?
- A previous perianal abscess that did not heal completely — by far the commonest cause
- Infection of the anal glands inside the anal canal (cryptoglandular infection)
- Crohn's disease and other inflammatory bowel disease
- Tuberculosis, which remains an important cause of fistula in India
- Complications of surgery or trauma in the anal region
- Obstetric injury during childbirth
- Hidradenitis suppurativa and other chronic skin infections
- Radiation to the pelvis, and rarely cancer of the anal region
Who is more likely to be affected
- A drained perianal abscess in the past
- Diabetes and other conditions that impair healing
- Crohn's disease or ulcerative colitis
- A weakened immune system, including HIV
- Smoking, which slows wound healing significantly
- Long-standing untreated piles or fissure with recurrent infection
When to see a doctor immediately
- Any discharge of pus near the anus, even if it comes and goes
- A perianal swelling with fever or spreading redness — this needs urgent drainage
- Pain severe enough to prevent sitting or sleeping
- A fistula that has returned after previous surgery
- Discharge along with diarrhoea, weight loss or mouth ulcers, which may point to Crohn's disease
How it is diagnosed
Medical history
The surgeon asks about the discharge, whether you have had an abscess drained before, how many times the swelling has recurred, and about any bowel symptoms — because a fistula caused by Crohn's disease is treated very differently from an ordinary cryptoglandular one.
Clinical examination
The external opening is located and the surrounding skin assessed. Gentle pressure often expresses a little pus, which confirms an active tract. The position of the external opening gives the surgeon a strong clue about where the internal opening lies.
Digital rectal examination
Assesses sphincter tone and may allow the surgeon to feel the tract as a firm cord, and sometimes the internal opening itself. Sphincter tone matters, because it influences which procedure is safe for you.
Proctoscopy
A short lighted tube examines the anal canal to identify the internal opening and to look for coexisting piles or a fissure, which are common and may need treating in the same sitting.
MRI fistulogram
The gold standard for complex, recurrent or high fistulas. It maps the entire tract, its relationship to the sphincter muscles, and any hidden side branches or collections. Operating on a complex fistula without this map is the commonest reason fistulas recur.
Endoanal ultrasound
An alternative or complement to MRI in some centres. It gives a detailed picture of the sphincter muscles and the tract, and is particularly useful for assessing sphincter integrity before surgery.
Colonoscopy
Advised when Crohn's disease is suspected — multiple fistulas, associated diarrhoea, weight loss, or a fistula that keeps recurring despite technically sound surgery.
How the options compare
| Feature | Conventional Fistulotomy | Sphincter-sparing (Laser / VAAFT / LIFT) |
|---|---|---|
| Sphincter muscle | Partly divided | Preserved |
| Continence risk | Present, higher in high tracts | Very low |
| Open wound | Yes, heals from the base up | Minimal or none |
| Wound dressings | Daily, for several weeks | Few or none |
| Pain after surgery | Moderate | Minimal |
| Healing time | 6 to 12 weeks | 3 to 6 weeks |
| Return to work | 2 to 3 weeks | 3 to 7 days |
| Cure rate | Highest, around 95% in low fistulas | 85–90%, repeatable if it fails |
| Best suited to | Simple, low, single tracts | High, complex or recurrent tracts |
Types of treatment
Supportive care (never a cure on its own)
Antibiotics
Settle an acute flare-up and control spreading infection, and are essential when an abscess is present. They do not close the tract, so the discharge returns once they are stopped — antibiotics buy time, they do not treat the fistula.
Abscess drainage
When pus has collected, it must be drained urgently. This relieves the pain immediately and prevents the infection spreading, but the fistula that follows still needs definitive treatment later.
Sitz baths and local hygiene
Warm sitz baths two to three times a day keep the area clean, reduce discomfort and protect the surrounding skin from excoriation while you await or recover from surgery.
Sphincter-sparing procedures
Laser fistula closure (FiLaC)
A fine laser fibre is passed along the tract and withdrawn slowly, delivering energy that destroys the lining and seals the tunnel behind it. The sphincter is not cut at all, there is no open wound, and most patients are back to routine within a few days. Our most commonly recommended option for suitable tracts.
VAAFT (video-assisted anal fistula treatment)
A miniature endoscope is passed into the tract so the surgeon can actually see the inside of it — including side branches that would otherwise be missed — before cauterising the lining and closing the internal opening. Its great strength is that nothing is left unmapped, which is why it suits recurrent fistulas.
LIFT (ligation of the intersphincteric fistula tract)
The tract is approached through the groove between the two sphincter muscles, tied off on both sides and divided there. Because the work is done between the muscles rather than through them, continence is preserved. Well suited to transsphincteric fistulas.
Advancement flap
A flap of healthy tissue from inside the rectum is mobilised and stitched over the internal opening, cutting off the tract's source of infection. Reserved for complex or high fistulas where cutting muscle is not an option.
Conventional and staged procedures
Fistulotomy (laying open)
The tract is opened along its length and allowed to heal from the base upwards. It remains the highest cure rate of any technique for simple, low fistulas, at around 95%. It is only offered when the amount of muscle involved is small enough to be safe.
Fistulectomy
The entire tract is excised rather than laid open. It gives tissue for biopsy, which is valuable when tuberculosis or Crohn's disease is suspected, but leaves a larger wound that takes longer to heal.
Seton placement
A fine thread is passed through the tract. A draining seton keeps infection from collecting and lets inflammation settle before a definitive procedure; a cutting seton is tightened gradually so the muscle divides slowly and heals behind itself. Often the first stage in treating a complex fistula.
Fistula plug or fibrin glue
A bioabsorbable plug or tissue glue is used to seal the tract. Completely sphincter-safe and worth trying in selected patients, though success rates are lower and less predictable than the other options.
What happens, step by step
- 1
Consultation and examination
20–30 minutes- A proctologist reviews your history, including any previous abscess or surgery
- The external opening is examined and the tract assessed
- You are told clearly whether the fistula is simple or complex — and why that decides the plan
- 2
Imaging, where it is needed
Before the surgery date- An MRI fistulogram is arranged for complex, high or recurrent fistulas
- The full tract, its side branches and its relation to the sphincter are mapped
- Blood tests, sugar control and an ECG are reviewed
- Your surgeon chooses the technique on the basis of this map, not guesswork
- 3
Admission and pre-operative preparation
30–60 minutes- Your coordinator completes the admission formalities with you
- Vitals are recorded and the reports reviewed by surgeon and anaesthetist
- Consent is taken and an IV line is started
- The surgical area is prepared
- 4
Examination under anaesthesia
5–10 minutes- Spinal or short general anaesthesia is given — the procedure is painless
- With the sphincter relaxed, the surgeon confirms the tract and locates the internal opening
- The final choice of technique is confirmed at this point
- 5
The definitive procedure
30–60 minutes- The tract is treated by laser closure, VAAFT, LIFT or fistulotomy as planned
- The internal opening is closed or dealt with — the step that decides whether it recurs
- Any side branches or collections found are cleared in the same sitting
- A draining seton is placed instead if the tissues are too inflamed to close safely today
- 6
Recovery room observation
1–2 hours- Vitals and pain are monitored as the anaesthesia wears off
- Oral fluids are started once you are fully awake
- You are encouraged to walk before discharge
- 7
Discharge and follow-up
Same day, or within 24 hours- Most patients go home the same evening
- Painkillers, antibiotics and stool softeners are prescribed
- Sitz baths, dressings and hygiene are explained in detail
- Your free cab drops you home, and follow-up visits are scheduled until the wound has healed
How to prepare
- Complete the blood tests, ECG and any MRI your surgeon has advised
- Tell your surgeon about diabetes, blood thinners or immunosuppressant medication
- Stop smoking well before surgery — it measurably delays fistula healing
- Start the prescribed stool softeners so the first bowel movement afterwards is soft
- Fast for 6–8 hours before the procedure as instructed
- Arrange for an adult attendant to accompany you
Why patients choose this procedure
The discharge finally stops
Closing the tract and dealing with the internal opening ends the constant soiling, the pads and the smell that patients usually find harder to live with than the pain itself.
Continence is protected
Laser closure, VAAFT and LIFT treat the fistula without dividing the sphincter, so the risk of losing control over stool or gas is very low.
No more recurrent abscesses
Once the tract is closed, the cycle of painful swellings that build up, burst and return is broken.
Daycare procedure
Admission and discharge on the same day in most cases, rather than a multi-day hospital stay.
Minimal wound care
The sphincter-sparing techniques leave little or no open wound, so the weeks of daily dressings that follow a conventional fistulotomy are largely avoided.
Repeatable if needed
If a laser or VAAFT procedure does not fully close the tract, it can be repeated or another technique used — nothing has been burnt behind you, because no muscle was cut.
Possible risks and side effects
Recurrence
The most important risk with any fistula surgery. It usually happens when the internal opening was missed or a side branch was left behind, which is exactly why mapping the tract properly beforehand matters so much. A recurrent fistula can be treated again.
Difficulty controlling gas or stool
Mainly a concern with fistulotomy in high tracts, where more muscle has to be divided. It is the reason sphincter-sparing techniques are preferred whenever the anatomy allows, and why your surgeon assesses sphincter tone before deciding.
Pain and discomfort
Expected for the first few days and well controlled with the prescribed painkillers. It is generally less than the pain of the recurrent abscesses that brought you in.
Bleeding
Minor bleeding or spotting for a few days is normal. Heavy or persistent bleeding should be reported immediately.
Infection or a fresh abscess
Can occur if the tract blocks before it has healed. Fever, increasing pain or a new swelling needs to be reported at once rather than waiting for the next appointment.
Slow healing
Fistula wounds heal from the base upwards and take time. Diabetes, smoking, Crohn's disease and tuberculosis all slow this down, which is why those conditions are treated alongside the surgery rather than after it.
What recovery looks like
Recovery after fistula surgery is a longer road than after piles or fissure surgery, and it is worth knowing that at the outset. The procedure itself is a daycare one, but the tract heals from the inside out, and that takes weeks rather than days.
First 48 hours: expect soreness, some serous or blood-stained discharge, and a dressing that needs changing. Take the painkillers, antibiotics and stool softeners exactly as prescribed. Begin warm sitz baths for 10–15 minutes, two or three times a day and after every bowel movement.
Days 3 to 7: most patients with desk jobs return to work. Discharge from the wound reduces steadily. Keep the area clean and dry between sitz baths, and continue the high-fibre diet and plenty of water so bowel movements stay soft.
Weeks 2 to 6: the tract closes progressively. If you had a conventional fistulotomy, dressings continue until the wound has filled in from the base. Avoid heavy lifting, cycling and long periods of sitting on hard surfaces. Follow-up visits confirm that healing is happening from the depth upwards and not just closing over at the skin — a wound that seals on the surface too early is how a fistula comes back.
If a seton was placed, it stays in for several weeks to keep the tract draining while inflammation settles, and the definitive procedure follows afterwards. Your coordinator will explain that timeline clearly before you go home.
Contact your care coordinator immediately if you develop fever, increasing pain, a fresh swelling, heavy bleeding, or if the discharge suddenly increases after having settled.
What to eat and what to avoid
Recommended
- High-fibre foods — oats, whole grains, dals and pulses
- Papaya, guava, pear, banana and other soft fruit
- Green leafy vegetables and salads
- 3 to 4 litres of water through the day
- Protein-rich foods such as eggs, paneer, fish and dals, which support wound healing
- Curd, buttermilk and other probiotics, especially while on antibiotics
- Soaked figs, raisins or isabgol (psyllium husk) at night
Best avoided
- Spicy and heavily masala-laden food
- Deep-fried and processed food
- Maida and refined-flour products
- Alcohol, which interferes with antibiotics and delays healing
- Smoking and tobacco in any form — the single worst thing for fistula healing
- Prolonged sitting on hard surfaces, and delaying the urge to pass stool
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Fistula treatment cost
₹45,000 – ₹1,20,000
The range is wider than for piles or fissure because fistulas vary enormously. A simple, low, single-tract fistula sits at the lower end; a high, branching or recurrent fistula that needs an MRI, a seton stage and then a definitive procedure sits at the upper end. Your city, the hospital and your room category also matter. Fistula surgery is covered by most health insurance policies — our insurance desk checks your eligibility and files the cashless request before admission, at no charge.
Inside the care journey
Fistula — your questions answered
No. This is the one condition in proctology where medicine genuinely cannot cure the problem. Antibiotics settle a flare-up and dry the discharge temporarily, but the tunnel and its infected internal opening remain, so the discharge returns once the course finishes. Definitive treatment requires a procedure.