Minimally Invasive Procedures for Fistula

Maher A. Abbas, MD
Compassion, Excellence, Integrity

Diplomate, American Board of Surgery

Diplomate, American Board of Colon and Rectal Surgery

Fellow, American College of Surgeons

Fellow, American Society of Colon and Rectal Surgeons

Honorary Fellow, Philippine Society of Colon and Rectal Surgeons

Honorary Member, Surgical Section Serbian Medical Association

“The best interest of the patient is the only interest to be considered…”W.J. Mayo, MD (Founder of the Mayo Clinic)


Dr. Maher Abbas is an American Board Certified Colon and Rectal Surgeon who performs the latest and most advanced procedures to treat conditions affecting the small intestine, colon, rectum, and anus.  He is a leader in minimally invasive and endoscopic surgery. With over 18,000 operations and procedures experience, he provides state of the art treatment to his patients.


What is the best treatment for anal fistula?

Anal Fistula is a complex condition which requires expert care.  The only effective treatment is a surgical procedure.  The goals of any fistula intervention are to heal, minimize the risk of the procedure, decrease the possibility of recurrence, and preserve anal function and continence.  Dr. Maher Abbas believes in customizing the care according to the needs of the patient.  He recommends for each patient what is the best treatment based on a personalized approach.    Dr. Maher Abbas is an expert in anal fistula treatment and he offers the entire spectrum of surgical procedures and operations.

For additional information on the various treatment options for anal fistula, click here.

What are the benefits of minimally invasive procedures for anal fistula?

Minimally invasive procedures yield many benefits including less pain, faster recovery, and earlier return to work.   The procedures are performed in the operating room under a spinal anesthetic or a brief general anesthetic.    Most patients are able to go home within 24 hours of the procedure and usually resume work within 1 week.


What are minimally invasive procedures for anal fistula?

Minimally invasive procedures result in minimal wound and scarring, least pain, and fastest recovery.  The following are such procedures:

  • Seton insertion. This simple procedure entails inserting a string through the fistula tract to allow for proper drainage [Figure 1].  Often this intervention is performed in preparation for a second procedure but on rare occasions, the seton is gradually tightened to slowly rid of the fistula

Figure 1 – Seton

  • Laser procedure.  Laser obliteration of the fistula tunnel (a procedure known as FiLac™) entails burning the inside of the fistula in order to scar it.   Laser energy is produced by a generator [Figure 2] and the energy is delivered by a flexible laser catheter which delivers the laser beam at its tip [Figure 3].  Drying of the fistula is noted after a successful procedure

Figure 2 – Laser machine

Figure 3 – Laser probe for fistula treatment

  • Video assisted fistula procedure.  The VAAFT procedure (video assisted anal fistula treatment) is similar in concept to the laser procedure.  A rigid endoscope is inserted through the skin opening of the fistula and guided to the internal opening.  A heating energy is used to coagulate and scar the fistula tract [Figure 4]

Figure 4 – Video assisted anal fistula treatment surgery

  • Injectable glue and plugs. A biological glue is injected through the external fistula tract after brushing and cleaning the fistula.  The glue is inserted to seal the fistula.  Alternatively, a plug is introduced inside the fistula.  These procedures typically carry lower long-term fistula closure rate but they can be the appropriate treatment in a minority of patients

  • Evolving technologies. Several new technologies are on the horizon and include stem cell therapy, a new generation of plugs, and biodegradable clips.  While they are not currently available for widespread use, these therapies may become an option for patients in the near future.


Is every patient a candidate for minimally invasive procedures for anal fistula?

A minimally invasive procedure for anal fistula is appropriate in some patients.  Dr. Maher Abbas needs to assess each case taking into consideration the patient’s related factors and disease features in order to determine the most effective treatment for an individual patient.


Why seek expert care with a board certified proctologist and colorectal surgeon?

The anal area is a delicate part of the body.  It is important to seek care to heal, relieve symptoms, and to exclude other more serious causes of anal symptoms.  The expertise of the doctor is critical in order to ensure the best result and minimize the risk of recurrence, non-healing, infection, and developing any weakness in the anal muscle.  Proctology is a highly specialized field.

Dr. Maher Abbas is an expert in the treatment of diseases of the colon, rectum, and anus.  With over a 30-year career in the USA, he has completed advanced training in Proctology and is American Board Certified in Colon and Rectal Surgery.  Dr. Maher Abbas is a Fellow of the American Society of Colon and Rectal Surgeons.

If you would like to schedule a consultation with Dr. Maher Abbas to discuss your case, click here.

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