About us
Patient Information
Get the Right Care
Clinique Michel Gagner offers anal fistula surgery in Montreal for patients who require definitive treatment for this often persistent and uncomfortable condition.
An anal fistula is an abnormal tract that connects the inside of the anus or rectum to the outside perianal skin. It arises over time from an inflammatory process, such as an infected anal gland or an abscess near the anus. Over time, a tract forms through surrounding tissues, with both an internal fistula opening and an external opening on the skin.
These tracts can vary in complexity. Some stay close to the skin surface. Others, including intersphincteric fistula tracts, run deeper and may involve the anal sphincter. Causes range from an infected gland to conditions like Crohn’s disease, complications from previous surgery, or physical trauma can also contribute to their development. These fistulas vary in complexity, with some being relatively straightforward to treat and others requiring advanced surgical intervention due to their involvement of deeper tissues.
Left untreated, a fistula can perpetuate chronic infections or lead to systemic complications like sepsis (a life-threatening infection) and, in some cases, increase the risk of anal cancer.
If you suspect an anal fistula, consulting a colorectal surgeon is essential for accurate diagnosis and effective treatment.
Anal fistulas rarely heal without treatment, and surgery is often necessary to resolve the condition effectively. Without proper surgical drainage and repair, these abnormal tracts allow infections to persist, causing significant pain, swelling, and continuous discharge. In cases of complex or more advanced fistulas, the sphincter muscles may also be involved, complicating bowel control and leading to issues like fecal incontinence, which may require fecal incontinence surgery.
Diagnosis begins with a physical exam and may include imaging such as endoscopic ultrasound or MRI, particularly if the tract is difficult to localize or if there's concern about its connection to the large intestine.
A fistulotomy is a surgical procedure designed to treat anal fistulas by accessing the tract to allow it to heal while minimizing damage to the surrounding sphincter muscles. The approach may include incision and drainage or seton placement (a surgical thread used to keep the tract open and promote gradual healing), depending on the complexity of the fistula.
All forms of surgical treatment, whether they be big or small, carry risks. For anal fistula surgery, or a fistulotomy, these typically include:
Risks of Surgery
The primary purpose of a fistulotomy is to remove all the pus and fluids inside the fistula and affected area. Removing infected material will help the fistula opening heal faster and close the abnormal tunnel.
A fistulotomy is a minor outpatient surgery, meaning you can go home the same day. Before the procedure, a nurse or doctor will clean the affected area, confirm the surgical plan, and answer any questions you may have. An anoscope – a tool used to help doctors see inside the anus – may be used to help plan the surgery. Local anesthesia is typically used to numb the area and ensure you feel no discomfort, while general anesthesia may be recommended for more complex cases. The procedure itself can last anywhere between a few minutes to an hour depending on the size of the fissure at the time of surgery.
During the procedure, one of our surgeons will use a scalpel to cut into the fistula. Slight pressure will be applied to the site and the anal abscess will be drained. Subsequently, infected tissue surrounding the area will be entirely removed. Your surgeon will then stitch the incision and leave it to heal. In circumstances where the fistula is too large to stitch, the external opening will be packed with gauze and be left to heal in the open.
You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems. Your surgeon may recommend imaging tests like an ultrasound or MRI if the fistula is complex or its location is unclear, and further tests may be necessary to determine if the condition is related to Crohn’s disease.
Recovery time for a fistulotomy will vary, but you should feel back to normal within a few weeks. Residual pain may last up to a week after surgery. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.
You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication. You can refer to our surgery guidelines for more detailed, pre-op and post-op instructions.
At Clinique Michel Gagner, we provide specialized surgical care for patients seeking anal distual surgery in Montreal. Every case is assessed individually to determine the safest, most effective treatment plan, with a focus on precision, recovery, and long-term results.
Our surgical team offers a wide range of procedures, including not only fistulotomy surgery, but also diagnostic surgery, bariatric surgery, and other general surgical services.
If you have questions about costs, insurance, or scheduling, you’ll find more details on our fees page. Our administrative team is available to answer your questions.
If you're experiencing symptoms or have been advised to consider surgery, we encourage you to book an appointment for a consultation. Early evaluation allows us to treat the condition before it becomes more difficult to manage.
Did you know we have a support group?
Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.