Fistula Repairs of the Lower Bowel
Seton, Fistulotomy, Fibrin Glue, Fistula Plug, Endorectal Advancement Flap
A fistula is an abnormal tract between the
bowel and another structure. Fistulas can be
a result of injury or surgery. It can also
result from infection or inflammation.
Treatment depends on where the fistula is
and how complex it is. An anal fistula is
almost always the result of an abscess.
A small gland just inside the anus becomes
infected when bacteria or foreign matter
enters the tissue through the gland. If not
treated, the abscess can grow from the anal
gland and tunnel to the surface of nearby
skin. If this tunnel does not heal, a fistula
develops. Certain conditions, colitis or other
diseases of the bowel can sometimes make
these infections more likely. Fistulas can
cause pain, fever, and drainage. Healing a
fistula can be a slow and difficult process.
The key to healing a fistula is to find the
internal opening. It may take a few surgical
attempts to find this opening.
Seton: A seton is like a string made out of
an inert silicone or a braided suture. These
materials are not absorbed by the body. The
seton can be placed through the entire fistula
tract and the ends are brought together and
tied. The seton may be left in place for any
length of time. The purpose is to provide
controlled drainage, decreasing
inflammation and allowing a scar to form
along the tract. There may be pain. Expect to
have normal bowel function with a seton in
Once all the inflammation has resolved, and
a mature tract has formed, surgery may then
be an option. This is called a staged
procedure. A cutting seton is used when the
anal muscles are involved. This type of
seton helps avoid damage to the muscles.
The seton is slowly advanced through the
muscles, creating a scar as it heals, closing
the tract. Setons can be used alone or
combined with surgery.
Fistulotomy: Surgery opens the fistula
tract and joins the inner and outer openings.
This converts the tunnel to a groove. The
groove heals from the inside out.
Endorectal Advancement Flap: A
flap is created from the rectal wall to cover
the internal fistula opening. By closing the
source of the drainage, the tract and external
wound can heal over time. You will need to
eat a low fiber and residue diet after surgery.
Full bowel prep with antibiotics.
L.I.F.T: This stands for litigation of
intersphincteric fistula tract. It is a method
for treading a complex or deep fistula.
This procedure is usually done in two-parts.
A seton is placed into the fistula tract and
this widens the tract over time. In most
cases 4-6 weeks later surgery involves a new
small incision between the sphincter
muscles and the mid portion of this tract is
stitched closed. This allows the internal and
external openings to collapse and heal.
The success rate is about 60% and this
surgery has a longer time in which it can
fail. There may be drainage from the
surgical site that can last 2 months. This
surgery preserves the sphincter so there is a
zero to rare chance of incontinence being
caused by this surgery. Full bowel prep is
needed for this surgery.
Ostomy: A temporary opening in the
abdomen to divert waste into a collection
bag, to allow the anal area time to heal. Full
bowel prep with antibiotics.
Day before Surgery: Bowel Prep
Most patients need to drink some type of
laxative to prepare for surgery. It will
depend on your own special case. The
bowel prep will be one of these:
ξ No solid food and drinking only
clear liquid diet
ξ Clear liquid diet, magnesium citrate,
ξ Full bowel prep – Laxative pills,
drinking GoLYTELY® until stools
are clear, antibiotic pills and enema
Your bowel prep will be prescribed ahead of
time. We will discuss the details of it with
you before surgery.
ξ You may have an open wound, this
will depend on your surgery.
ξ Take a sitz bath at least 3-4 times a
day and after each bowel movement.
This will help decrease the pain of
rectal spasms and aid healing. Sit in
a bathtub or portable sitz bath of
warm water for 10-20 minutes.
ξ Avoid hard wiping of the area for the
first few days. Do not use toilet
paper, instead, use alcohol-free
ξ You will have reddish-yellow
drainage for at least 7-14 days. You
will need mini-pads or sanitary
pads for your underwear during this
time. The drainage will decrease in
amount and get lighter in color.
With bowel movements and more
activity you may notice an increase
of bloody drainage.
Pain after surgery may be mild to severe for
the first week and may last longer than you
expect. Pain medicine will be prescribed.
Follow the instructions from your
pharmacist on how to take these pain pills.
With future surgeries in this area, you may
have more pain at first, because of the
increased exposure of nerve endings.
While on pain pills, you may be asked to
take a stool softener (Docusate sodium) and
a bulk fiber laxative such as Metamucil® to
prevent problems with constipation. These
will help the stool pass more easily. You can
buy these over-the-counter. Follow package
1. Seton, fistulotomy, fibrin glue,
fistula plug, advanced flap: may
resume general diet as tolerated.
2. Ostomy: follow a low residue diet
right after surgery. At your first
post-op visit, we will discuss
changes in diet. We will give you a
handout that describes this.
ξ For comfort, change your position
often, sitting to standing to lying
down as needed.
ξ You may return to work as soon as
you are comfortable and not taking
ξ Do not drive while on narcotics.
ξ Sex may be resumed when you are
ξ You will return to see your doctor in
1 – 3 weeks.
When to Call the Doctor
ξ Large amount of bright red blood
that does not stop with pressure to
the area for 10 minutes
ξ Temperature over 100.4ºF for 2
readings taken 4 hours apart. Take
your temperature once a day for a
ξ Foul-smelling drainage
ξ Excess or new swelling
ξ Problems having or controlling
ξ Signs that your fistula has returned
ξ Severe pain
ξ Trouble passing urine
Digestive Health Center:
After hours, weekends and holidays ask
for the doctor on call. Leave your name and
phone number with area code.
We will call you back.
Toll Free: (855) 342-9900
References: American Society of Colon and Rectal Surgeons, Medline Plus the National Institutes of Health, UWHealth.org. and the Illustrative
Handbook of General Surgery, Springer 2010.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 12/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7597