The type of fistula repair surgery performed depends on the fistula's complexity and location, but may include a fistulotomy, fibrin glue and collagen plug, seton placement, or an advancement rectal flap, according to Mayo Clinic. More complex fistulas may require an ostomy and stoma or a muscle flap.
In a fistulotomy, the fistula's internal opening is cut, the infected tissue is scraped and flushed, and then the channel is flattened and stitched closed, details Mayo Clinic. Instead of stitches, a fibrin glue and collagen plug procedure requires a fibrous protein glue or collagen plug to close the fistula after cleaning it out.
The surgeon puts a latex or silk string into the fistula to drain the infection in a seton placement procedure, notes Mayo Clinic. Prior to removing a fistula's internal opening in an advancement rectal flap procedure, a flap is created from the fistula's internal opening, which is used to cover the repair after the procedure is complete.
When a more invasive approach is required, an ostomy and stoma are performed, wherein a temporary opening in the abdomen is created so waste is diverted to a collection bag, explains Mayo Clinic. The procedure allows the anal area time to heal. Heavy tissue from the buttocks, labia or thigh is used to fill the channel in extremely complex fistulas.