Anal Fistula Surgery in Turkey

Anal fistula surgery in Turkey is a specialized procedure performed to treat abnormal tunnels that form between the anal canal and skin. Left untreated, anal fistulas can cause chronic infection, pain, and discharge. Turkish hospitals provide modern surgical techniques, ensuring effective treatment and reduced recurrence rates.

Cost of anal fistula surgery in Turkey is lower compared to Western countries, making it a preferred destination for international patients. Packages typically include pre-operative consultation, diagnostic tests, surgery, hospital stay, and follow-up care. Affordable pricing combined with advanced medical facilities ensures high patient satisfaction.

Surgical methods for anal fistula treatment in Turkey include fistulotomy, seton placement, and minimally invasive laser techniques. The choice of method depends on the fistula’s complexity, location, and patient’s overall health. Experienced colorectal surgeons prioritize sphincter preservation to minimize risks of incontinence.

Recovery after anal fistula surgery in Turkey is usually straightforward. Most patients resume normal activities within a few days to weeks, depending on the surgical method. Post-operative care includes wound management, pain control, and dietary adjustments. Comprehensive follow-up support ensures proper healing and long-term success.

General Surgery Specialist
Who is Dr. Ahmet Bekin?

Dr. Ahmet Bekin, one of the doctors performing hernia surgeries in Istanbul, is specialized in general surgery. Throughout his medical career, he has gained extensive experience in hernia, reflux, and obesity surgery, as well as advanced laparoscopic and robotic surgical applications. He serves his patients with modern approaches such as minimally invasive surgery, laser surgical treatments, single incision surgery (Single Incision Surgery), endocrine and oncological surgery. He is fluent in Turkish, English, and Arabic.

• 2000 – 2006 Kocaeli University Faculty of Medicine
• 2006 – 2011 Istanbul University Faculty of Medicine (Çapa), Department of General Surgery – Specialization

What Is an Anal Fistula?

An anal fistula is a small, abnormal tunnel that forms between the anal canal and the skin near the anus. It typically develops as a result of a previous anal abscess that failed to heal completely. Anal fistulas often cause symptoms such as persistent pain, swelling, skin irritation, and discharge of pus or blood. Surgical intervention is usually required to fully close the tract and prevent recurrent infections or abscesses.

What Are the Causes of Anal Fistula?

Anal fistula is a serious health problem that can occur for various reasons. The most common cause is infection of the anal glands, leading to abscess formation. When the anal glands become blocked, bacteria multiply easily, resulting in an abscess. Untreated abscesses eventually form a tract between the perianal skin and the anal canal, leading to fistula development.

Crohn’s disease is a significant risk factor for anal fistula formation. In this chronic inflammatory bowel disease, ongoing inflammation and ulceration in the bowel wall set the stage for abscess and fistula formation. Studies show that perianal fistula develops in about 30% of individuals with Crohn’s disease. Ulcerative colitis, though less common, can also lead to anal fistula. Prolonged inflammation of the bowel mucosa in this disease, especially in severe cases, can cause complications and fistula formation.

Physical trauma, such as anal surgery, childbirth, or injury, is associated with damage to the anal glands and subsequent infection, leading to fistula development. Repeated anal intercourse can also increase the risk of microtrauma and infection.

Radiation therapy to the pelvic region can damage anorectal tissues and reduce blood flow, increasing the risk of infection and thus fistula formation. Chronic infections such as tuberculosis and hidradenitis suppurativa are also risk factors for fistula development. These infections, especially in regions where tuberculosis is common, can trigger abscess and fistula formation.

Although rare, some types of cancer and congenital anomalies can also play a role in fistula development. Tumor invasion or treatment methods in anorectal cancers can cause abnormal connections between the anal canal and the skin.

How Common Is Anal Fistula?

Anal fistula is considered a rare disease in the community but can cause significant discomfort and complications. Its prevalence varies among different geographic regions and demographic groups. A comprehensive literature review in 2018 revealed that the incidence of anal fistula can reach up to 21 cases per 100,000 people. However, these rates may vary among different societies and healthcare systems.

In terms of gender, anal fistulas are 2 to 6 times more common in men than in women. This marked difference is largely attributed to anatomical and hormonal factors. The wider anal gland structure in men is thought to predispose them to infection. Regarding age, anal fistulas most commonly occur between the ages of 30 and 50. They are quite rare in children and the elderly and are usually associated with another underlying disease in these groups.

Geographical differences can also affect the frequency of anal fistula. For example, in the United Kingdom, the incidence is reported as 8.6 per 100,000 people, while in Scandinavian countries, this rate increases to 12.3. These differences may be due to access to healthcare, standards in diagnostic methods, and genetic predisposition. The use of advanced imaging techniques has enabled more accurate detection of this disease.

Anal fistulas are closely associated with inflammatory bowel diseases such as Crohn’s disease. The risk of developing an anal fistula in individuals with Crohn’s disease can be as high as 30%. Therefore, the presence of underlying diseases should be carefully evaluated.

How Does an Anal Fistula Develop?

The development of an anal fistula is usually directly related to the anatomy of the anal canal and the progression of infections. The anal canal contains mucus-producing anal glands to facilitate the passage of stool. These glands open into the anal canal via small ducts at the dentate line. If one of these ducts becomes blocked, an abscess forms in the infected gland.

Due to the blockage, bacteria multiply and cause infection, leading to the accumulation of pus and formation of an abscess. When an abscess forms, patients often experience severe pain, swelling, and sometimes fever around the anus. If left untreated, this situation can become more complicated.

If the abscess is not properly treated or does not drain spontaneously, the accumulated pressure allows the infected material to spread into the surrounding tissues. This spread creates a tract between the anal gland and the perianal skin, defined as an anal fistula. The fistula tract allows continuous drainage of infected material, becoming a chronic source of drainage.

Anal fistulas are classified according to their anatomical location and relationship with the sphincter muscles. The most common type is intersphincteric fistulas, located between the internal and external sphincter muscles. More complex types include transsphincteric, suprasphincteric, and the rarely seen extrasphincteric fistulas. This classification is critical for determining the treatment approach.

The severity of the infection, underlying diseases (such as Crohn’s disease), and anatomical factors play a decisive role in fistula development. Chronic fistulas may cause recurrent infections and abscesses as the external opening closes and reopens intermittently. If left untreated, this cycle can severely affect the patient’s quality of life.

What Are the Symptoms of Anal Fistula?

Anal fistula is typically characterized by chronic pain and discomfort that negatively affects the quality of life. One of the most common symptoms is sharp or throbbing pain felt around the anus and perianal area. This pain intensifies especially during sitting, walking, and defecation. The inflammation caused by the fistula and the irritation of surrounding tissues are the main reasons for this pain.

Swelling and redness are other common symptoms of anal fistula. Depending on the presence of infection, this can be accompanied by a feeling of warmth and usually presents as a palpable lump. The size and extent of the swelling may vary according to the size of the fistula and the degree of infection.

One of the most distinctive signs of a fistula is discharge. Purulent or bloody discharge from the external opening around the anus is usually foul-smelling and can lead to hygiene problems. This discharge may cause irritation and itching (pruritus ani). Itching can further irritate the skin and increase the risk of secondary infection.

Systemic infection symptoms such as fever and weakness can be seen in advanced cases of the fistula. These symptoms usually indicate that the infection is spreading to the surrounding tissues or bloodstream and require urgent medical intervention. Less frequently, minimal bleeding during defecation can occur due to damage to delicate tissues.

Due to constant discharge from the fistula, maceration (softening) of the skin may occur. This increases the risk of skin infection and can worsen discomfort. Some patients may also experience recurrent abscesses that may require surgical drainage.

How Is Anal Fistula Diagnosed?

Diagnosis of anal fistula begins with careful history taking and a thorough physical examination. Patients often present with complaints of discharge, pain, swelling, or bleeding in the anal region. These symptoms may indicate the presence of infection or fistula. During the examination, the perianal region is carefully inspected for external openings, indurations under the skin, and the presence of purulent material. Digital rectal examination may reveal induration, sphincter tone, and possible internal openings of the fistula.

During physical examination, the Goodsall rule can be used to predict the direction of the fistula tract. If the external opening is located anteriorly, the tract usually follows a straight path, while posterior openings tend to curve to the posterior midline. However, this rule may not always apply, especially for openings farther than 3 cm. Therefore, the Goodsall rule can be used as a guide but should be supported by other methods for a definite diagnosis.

Imaging techniques can clarify the diagnosis in more complex or uncertain cases.

Magnetic Resonance Imaging (MRI): The gold standard for assessing anal fistulas. Due to its soft tissue contrast, it provides detailed visualization of the fistula tract, internal openings, and possible abscesses.

• Endoanal Ultrasound (EUS): Used especially to evaluate the status of the sphincter muscles. Although it is a more economical option, it depends on operator experience.
• Fistulography: A less preferred method, usually used when other techniques are not feasible.

In complex cases, examination under anesthesia may be performed. This allows for a more detailed assessment while the patient is relaxed. If necessary, surgical intervention can also be performed in the same session.

How Is Anal Fistula Treated?

Treatment of anal fistula varies according to the structure of the disease, the relationship of the fistula with the anal sphincter muscles, and the patient’s overall health status. The goal of treatment is to completely heal the fistula, preserve sphincter function, and minimize the risk of recurrence.

One of the most common methods is fistulotomy. This technique is used for simple fistulas that minimally affect the sphincter muscles. The tract is surgically opened to allow natural healing. However, in cases where most of the sphincter muscles are affected, alternative methods such as seton placement may be preferred. The seton provides infection control and drainage and helps preserve the sphincter. Especially cutting setons allow controlled division of the sphincter muscle to achieve healing.

The LIFT procedure is another surgical technique that preserves the sphincter muscles. The fistula tract between the sphincter muscles is tied off, eliminating the focus of infection. This method is frequently preferred due to its high success rates and low risk of complications.

The advancement flap technique is an effective option for complex or high fistulas. The fistula canal is closed using a healthy tissue flap to support healing. This method is useful in cases where preserving sphincter integrity is critical.

Minimally invasive methods such as fibrin glue injection and fistula plug focus on preventing sphincter damage. Fibrin glue, as a biological adhesive, promotes closure of the canal, while the fistula plug fills the canal with biological material. However, the success rates of these techniques may vary in complex fistulas.

Finally, innovative techniques such as VAAFT (Video-Assisted Anal Fistula Treatment) provide sphincter-preserving treatment with minimally invasive approaches. The fistula canal is directly visualized, cleaned, and closed.

What Are the Complications of Anal Fistula?

If left untreated, anal fistula can lead to a series of serious complications. These complications can deeply affect both physical health and the patient’s quality of life. Some of the most common complications include:

• Chronic Infection and Sepsis:
  Anal fistulas, being associated with infected tissues, carry a constant risk of infection. If these infections are not treated, bacteria can spread through the fistula tract into the body, causing a life-threatening systemic inflammatory response called sepsis. If not treated promptly, sepsis can lead to organ failure.
• Recurrent Abscess Formation:
  Untreated fistulas can cause recurrent abscesses in the anal region, resulting in severe pain, swelling, and tissue damage. Frequent abscess formation can cause further tissue damage and make the fistula tract more complex.
• Complexity of the Fistula Tract:
  Over time, fistula tracts can branch and extend into deeper tissues, making surgical treatment more difficult and reducing success rates. Complex fistulas may require more extensive surgical interventions and prolong the healing process.
• Anal Incontinence:
  Chronic inflammation and surgical interventions can damage the anal sphincter muscles, causing involuntary loss of anal function, such as fecal incontinence. This complication can negatively impact both physical and psychological health.
• Risk of Malignancy:
  Although rare, long-standing and untreated anal fistulas, especially in cases of chronic inflammation such as Crohn’s disease, carry a risk of malignant transformation. Therefore, regular monitoring of long-term fistulas is of great importance.
• Decreased Quality of Life:
  Persistent pain, discharge, and recurrent infections limit daily activities. In addition, these situations can create a heavy psychological burden. Untreated fistulas may lead to social isolation and depression.

When Can Anal Fistula Treatment Be Performed?

Treatment of anal fistula is determined by the severity of the patient’s symptoms, the anatomical structure of the fistula, and other underlying medical conditions. In the presence of an acute abscess, drainage of the infection and cleaning of the infected tissue should be prioritized. Treating the abscess may not prevent fistula formation but can prevent the spread of infection and more serious complications. Treatment of the fistula can be planned after this stage.

Simple, low-lying fistulas should generally be treated as soon as they become symptomatic. In such cases, surgical intervention is recommended based on symptoms such as discharge, pain, and recurrent infection that adversely affect daily life. Methods such as fistulotomy or fistulectomy are suitable for these cases, with a low risk of sphincter function loss.

Complex and high-lying fistulas require a more detailed evaluation. In such cases, sphincter preservation is critically important. For high-risk fistulas, seton placement, LIFT procedure, or endorectal advancement flap (ERAF) may be preferred. The timing of treatment should be compatible with the patient’s general health status, location of the fistula, and proximity to the sphincter muscles.

In patients with concomitant conditions such as inflammatory bowel disease, the timing of fistula treatment becomes even more important. In such cases, the treatment plan should focus on controlling the underlying disease and reducing the risk of infection. For example, minimally invasive methods may reduce recurrence risk during fistula treatment in patients with Crohn’s disease.

Minimally invasive methods can be considered for patients who are not suitable for surgery or are at high risk for general anesthesia. Options such as fibrin glue injection and anal fistula plug can be used to control symptoms and support fistula healing.

When Is Anal Fistula Treatment Contraindicated?

Although anal fistula treatment yields successful results in many patients, in some cases, initiation of treatment should be postponed or alternative approaches should be considered. Surgical interventions may vary according to the structure of the fistula and the patient’s general condition. However, certain situations may constitute contraindications for treatment and should be carefully evaluated.

First, in high transsphincteric or suprasphincteric fistulas that affect most of the anal sphincter muscles, the risk of incontinence after surgery may increase. A more cautious approach is required in such cases. Similarly, in patients with active inflammatory bowel disease (such as Crohn’s disease), fistula treatment may worsen symptoms and make healing more difficult. It is important to control the disease before starting treatment.

The presence of acute infection (abscess or cellulitis) is another condition in which surgical intervention should be postponed. Surgery performed without controlling such infections may increase the risk of complications and adversely affect healing. Therefore, infection must be fully treated as a priority.

Poor patient compliance, especially in long-term treatment methods such as seton placement, reduces the likelihood of success. If the patient does not actively participate in the treatment process, desired results may not be achieved. In addition, if there is significant anal sphincter damage, the planned treatment should be carefully considered, prioritizing sphincter preservation.

Another important situation is active anorectal sepsis or poor tissue quality. In regions exposed to radiation or containing dense scar tissue, healing may be difficult. The success of techniques such as flap advancement may be reduced in these patients. Likewise, very branched or complex fistulas may not be suitable for minimally invasive methods.

What Is the Healing Process After Anal Fistula Treatment?

The healing process after anal fistula treatment depends on the type of surgical intervention performed and the patient’s general health status. Approaches may range from less invasive methods such as fistulotomy, fistulectomy, or seton placement to complex surgical procedures such as flap advancement. The goal during recovery is to completely remove the infected tissue, ensure healthy closure of the wound, and improve the patient’s quality of life.

After surgery, the wound is usually left open to heal naturally, i.e., by secondary intention. This process minimizes the risk of infection and supports the formation of granulation tissue. Patients are advised to keep the wound clean and dry. Warm sitz baths increase blood flow in the perianal region, accelerate healing, and relieve discomfort. After using the toilet, the area should be gently cleaned, and non-irritating absorbent dressings should be used to prevent infection.

Pain management is a critical part of the healing process. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used to relieve mild to moderate pain. In more severe cases, short-term opioid use may be considered, but these drugs should be used cautiously due to side effects such as constipation. Topical anesthetics can also provide local relief.

Regulation of bowel movements is particularly important in the postoperative period. A fiber-rich diet, adequate fluid intake, and, if necessary, stool softeners are recommended. This minimizes pressure on the surgical area and reduces the risk of pain and wound dehiscence. Similarly, controlling diarrhea helps prevent irritation of the wound.

How Can Anal Fistula Be Prevented?

Preventing the development of anal fistula is an important step in avoiding the associated pain and complications. The following measures should be considered to prevent fistula formation:

• Early Treatment of Anorectal Infections
  Anorectal infections are among the most common causes of anal abscesses and fistulas. Early recognition and treatment of infections prevent abscess formation and fistula development. Therefore, if you experience pain, swelling, or discharge around the anus, consult a specialist without delay.
• Management of Inflammatory Bowel Diseases
  Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis increase the risk of anal fistula formation. Effective management of these diseases includes regular check-ups, appropriate medication, and lifestyle adjustments. Following your doctor’s advice reduces the risk of developing a fistula.
• Maintaining Anal Hygiene
  Good hygiene reduces the risk of infection and helps prevent fistula formation. Gently cleaning the anal area with water and mild soap after defecation can prevent the proliferation of microorganisms. Avoid harsh cleaning products or excessive rubbing.
• Preventing Anal Trauma
  It is important to avoid activities that may injure the anal area. Practice safe sexual habits and use condoms and appropriate lubricants. Trauma can set the stage for infection and increase the risk of fistula.
• Diet and Lifestyle Changes
  A fiber-rich diet and adequate fluid intake should be maintained to prevent constipation and straining. Regular bowel movements help prevent anal fissures and infections. Regular exercise also supports digestive health.
• Regular Medical Check-ups
  Individuals who have undergone anorectal surgery or have chronic diseases should regularly see a doctor for early detection of possible complications. Early diagnosis increases the chances of successful treatment.

Türkiye’nin En İyi Anal Fistül (Makat Çatlağı) Ameliyatı Yapan Doktorlara Sahip Olmasının Nedenleri

• Genel cerrahi alanında uzman hekimler: Türkiye’de göbek fıtığı (umbilikal herni) cerrahisinde deneyimli, laparoskopik ve açık cerrahi konusunda uzman birçok doktor bulunmaktadır.
• Modern cerrahi teknikler: Laparoskopik (kapalı) yöntemler, ağrıyı azaltan ve iyileşmeyi hızlandıran özel yama teknikleri (mesh) yaygın olarak kullanılmaktadır.
• Yüksek başarı ve düşük komplikasyon oranı: Ameliyat sonrası nüks (tekrarlama) oranı düşüktür; enfeksiyon ve komplikasyonlar nadirdir.
• Hızlı tanı ve planlama: Muayene, görüntüleme ve ameliyat süreci hızlı ve organize şekilde ilerler.
• Donanımlı cerrahi merkezler: Hem kamu hem özel hastanelerde teknolojik açıdan güçlü ameliyathaneler ve sterilizasyon sistemleri mevcuttur.
• İyileşme sürecinin yakından takibi: Ameliyat sonrası kontroller düzenli yapılır; hastaya özel beslenme ve hareket önerileriyle iyileşme desteklenir.
• Erişilebilir sağlık hizmeti: Gelişmiş cerrahi hizmetler, birçok ülkeye kıyasla daha ekonomik fiyatlarla sunulmaktadır.

Ortalama Anal Fistül (Makat Çatlağı) Ameliyatı Fiyatları Ne Kadar ?

Ortalama Anal Fistül (Makat Çatlağı) Ameliyatı fiyatları hastanın durumuna, cerraha ve ameliyatın yapılacağı ile ( İstanbul, İzmir, Ankara vb) değişiklik gösterebilir.

Anal Fistül (Makat Çatlağı) Ameliyatı Yaptıranların Yorumları

Dr. Ahmet Bekin'in hasta yorumları için Google Maps'e göz atabilirsiniz.

Türkiye'de Anal Fistül (Makat Çatlağı) Ameliyatı Yapan Doktorlar & Hastaneler

Anal Fistül (Makat Çatlağı) Ameliyatı Türkiye'de genel cerrahlar tarafından uygun alt yapıya sahip özel hastanelerde ve devlet hastanelerinde yapılır.

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Frequently Asked Questions

How long does anal fistula surgery take?

Anal fistula surgery usually takes between half an hour and one hour. The duration may vary depending on the structure, location of the fistula, and the presence of additional tracts. It is shorter in simple cases and may be a little longer in complex cases. The goal of the surgery is to close the fistula tract while preserving muscle control.

Which department/doctor should you see for an anal fistula?

Anal fistula is the formation of an abnormal tunnel or connection around the anus and often manifests with frequent discharge or pain. As this condition can become chronic over time, early diagnosis and intervention are very important. Hygiene problems can also be a trigger. You should consult a General Surgery specialist for the treatment of anal fistula. Thus, appropriate surgical techniques or other treatment options can be evaluated.

What is the recommended lying position after anal fistula surgery?

In the first days after surgery, lying on your side or lying on your back slightly supported with a pillow is recommended. This prevents direct pressure on the surgical site and relieves pain. If you need to sit, using special ring cushions can provide comfort. It is important to follow your doctor’s recommendations.

How many days of hospitalization are required after anal fistula surgery?

Most patients with simple fistulas can go home the same day. However, in complex or deeply located fistulas, especially if there are additional health problems, one or two days of hospital observation may be necessary. Regular dressing and follow-up after discharge will accelerate the healing process.

What happens if anal fistula surgery is not performed?

If left untreated, anal fistula can lead to recurrent abscesses and, in the long term, the development of more complex fistula tracts. Persistent discharge, pain, and risk of infection can significantly reduce quality of life. Rarely, chronic inflammatory processes may eventually transform into cancer. Early surgical intervention can prevent these problems.

What should be avoided after anal fistula surgery?

Avoid strenuous exercise and heavy lifting during the recovery period. Try to keep your sitting time as short as possible or use support cushions. Avoid contact with harsh soaps or irritating cleansers, and gently clean the area with warm water. Also, refrain from sexual activities not approved by your doctor to avoid straining the wound area.