Anal Fistula Surgery in Melbourne

The cost of anal fistula surgery depends on the complexity of the procedure, the surgical technique required, and your level of private health insurance cover. Fistulotomy and seton placement are Medicare-eligible procedures attracting rebates under the Medicare Benefits Schedule (MBS). With appropriate private hospital cover, out-of-pocket costs after Medicare and insurer rebates vary depending on your fund and policy level. Your specific out-of-pocket costs will be confirmed in writing before any procedure is scheduled. We recommend contacting your health fund to confirm your cover and any applicable waiting periods.

Most anal fistulas arise as a complication of an anorectal abscess. An abscess forms when one of the small glands inside the anal canal becomes infected and fills with pus. When the abscess is drained, either spontaneously or surgically, an epithelialised tract can persist between the internal gland and the surrounding skin, forming a fistula. A minority of fistulas are associated with underlying conditions, including Crohn’s disease, diverticular disease, radiation, or previous anorectal surgery.

Anal fistulas rarely resolve without surgical intervention. The fistula tract becomes lined with epithelium over time, preventing natural healing. Conservative measures, including antibiotics and local wound care, may reduce symptoms temporarily, but do not close the tract. Surgery is the only reliable pathway to definitive fistula closure in most patients.

The choice of procedure depends primarily on the anatomy of your fistula, assessed through clinical examination, MRI, and sometimes examination under anaesthesia. The key factor is the relationship of the fistula tract to the anal sphincter: a low fistula involving little sphincter muscle can generally be treated with fistulotomy, while a higher or more complex fistula requires a sphincter-preserving approach. We will discuss the most appropriate option for your individual anatomy at your consultation.

A seton is a thread or suture material passed through the fistula tract. A draining seton is used to keep the tract open and allow chronic infection to resolve while a plan for definitive closure is developed, and may remain in place for weeks to months. A cutting seton is slowly tightened over successive visits to gradually divide the sphincter muscle while allowing it to scar and tether, reducing the risk of incontinence. Setons are particularly useful for complex or high fistulas where immediate fistulotomy would carry an unacceptable risk of sphincter damage.

The ligation of the intersphincteric fistula tract (LIFT) procedure is a sphincter-preserving technique for transsphincteric anal fistulas. The surgeon makes an incision in the groove between the internal and external sphincter muscles and dissects down to the fistula tract, which is then ligated (tied off) and divided. Because the sphincter muscle itself is not cut, the risk of faecal incontinence is significantly lower than with fistulotomy for high fistulas. Recurrence rates are higher than with fistulotomy but comparable to other sphincter-preserving techniques ^[3].

Recovery depends on the type of procedure. After fistulotomy, most patients return to light activities within 1-2 weeks, though wound healing can continue for 6-12 weeks. After the LIFT procedure or advancement flap repair, recovery is generally similar, with most patients managing normal activities within 2 weeks. Patients with a seton in place can usually maintain normal daily activities throughout the seton period. We will give you a realistic recovery timeline based on your specific procedure.

Fistulotomy, seton placement, the LIFT procedure, and advancement flap repair are listed on the Medicare Benefits Schedule (MBS) when performed for appropriate clinical indications. Private health insurance typically covers the hospital and anaesthetic component for listed procedures, subject to your policy level and any applicable waiting periods. We will confirm the relevant MBS item numbers at your consultation and provide a written cost estimate before any procedure is scheduled ^[6].

You will receive specific pre-operative instructions from us before your procedure. In general, you should fast from food and clear fluids from midnight the night before surgery, take any prescribed bowel preparation as directed, arrange transport home on the day of surgery, as you will not be able to drive after a general anaesthetic, and plan to take 1-2 weeks off work for recovery. Avoid aspirin or non-steroidal anti-inflammatory drugs in the week before surgery unless we specifically advised you to continue these medications.