Anal Fistula Surgery in Mumbai– Dr. Husain Gheewala
About Dr. Husain Gheewala
Anal fistula surgery is the only definitive cure for an anal fistula. The right procedure, performed by an experienced colorectal surgeon, offers a high chance of permanent cure with preserved bowel control.
Dr. Husain Gheewala has performed hundreds of fistula procedures at leading South Mumbai hospitals. His training at York NHS Hospital (UK) and Severance Hospital (Seoul) — combined with over a decade of focused colorectal practice — covers the full range of conventional sphincter-preserving techniques used internationally.
When Is Surgery Needed for an Anal Fistula?
Anal fistulas rarely heal on their own. The tract is a fixed tunnel lined with infected tissue, and as long as it remains open, infection will continue to flare. Surgery is recommended when you have:
- Persistent discharge of pus, blood, or fluid from a small opening near the anus
- Recurrent abscesses that drain and return
- Throbbing perianal pain that worsens with sitting or passing stool
- Skin irritation around the anal area that does not settle
- Imaging or examination findings suggesting a fistula tract
Even if symptoms are mild, an untreated fistula can become more complex over time — developing branches or new abscesses — so early surgical assessment is recommended.
Pre-Surgery Assessment & Diagnostic Imaging
Successful fistula surgery depends on accurate mapping of the tract before the procedure. The assessment usually involves:
- Clinical examination including digital rectal examination
- Proctoscopy to identify the internal opening
- MRI Fistulogram — the most reliable test for complex or recurrent fistulas. MRI shows the full course of the tract, any side branches, and any undrained pockets of infection
- Examination Under Anaesthesia (EUA) — performed in the operating theatre when the tract is difficult to map in the clinic
This assessment tells Dr. Gheewala exactly which procedure will give you the best chance of cure while preserving sphincter function.
Surgical Procedures Performed
Dr. Gheewala performs the four conventional, evidence-based anal fistula procedures. Each is suited to a specific type of fistula. The choice is made after imaging and clinical assessment
Anal Fistula Surgery in Mumbai
Fistulotomy
Used for simple fistulas. The surgeon cuts open the length of the tunnel, allowing it to heal and flatten from the inside out.
Fistulotomy has long been considered the most reliable procedure for low, simple fistulas — those that do not cross significant sphincter muscle. The technique exposes the entire tract so it heals from the base upwards, which gives a low recurrence rate. It is performed as a day-care procedure under spinal or general anaesthesia. Recovery involves daily wound dressings and sitz baths over 6–8 weeks until the open wound closes from the inside out.
Best suited for: simple, low intersphincteric or submucosal fistulas in patients without inflammatory bowel disease.
Seton Placement
Used for complex or infected fistulas. A surgical thread or band is looped through the tract to hold it open, allowing continuous drainage of infection over several weeks.
A seton is a thin surgical thread that passes through the fistula tract and is tied loosely on the outside. It does two things: it keeps the tract drained so infection cannot build up into a new abscess, and it allows the tract to mature into a healthy fibrous channel ready for definitive surgery. In some patients — particularly those with Crohn’s disease or recurrent disease — a long-term seton is used as the main treatment to control symptoms without further surgery.
Best suited for: complex, high, or actively infected fistulas; the first stage of staged treatment for transsphincteric tracts; long-term symptom control in selected cases.
LIFT Procedure (Ligation of Intersphincteric Fistula Tract)
Used to protect the anal sphincter muscles. The surgeon accesses the tunnel between the sphincter muscles, seals both ends with sutures, and divides the tract.
LIFT is one of the most important sphincter-sparing techniques in modern colorectal surgery. Through a small incision between the internal and external sphincter muscles, the surgeon identifies the fistula tract, ties it off on both sides, and divides it. Because no sphincter muscle is cut, the risk of incontinence is very low. LIFT is usually performed after a seton has been in place for several weeks to allow the tract to mature.
Best suited for: transsphincteric fistulas where preserving sphincter function is essential; patients in whom continence is a particular priority.
Advancement Flap
The surgeon scrapes out the fistula tract and covers the internal opening with a healthy flap of tissue taken from inside the rectum.
In an advancement flap procedure, a flap of healthy rectal lining (mucosa and submucosa) is mobilised and pulled down to cover the internal opening of the fistula inside the anal canal. The infected tract itself is curetted out. Once the internal opening is closed by healthy tissue, the source of ongoing infection is removed and the fistula can heal. The sphincter muscle is not cut.
Best suited for: high transsphincteric or suprasphincteric fistulas; recurrent fistulas after previous procedures; patients in whom LIFT is not feasible.
Anal Fistula Surgery in Mumbai
Procedure Comparison
| Procedure | Best For | Sphincter Risk | Typical Recovery |
| Fistulotomy | Simple, low tracts | Low when used correctly | 6–8 weeks wound healing |
| Seton Placement | Complex or infected tracts; first stage | Very low — sphincter preserved | Seton in place several weeks |
| LIFT Procedure | Transsphincteric tracts | Very low — sphincter spared | 2–3 weeks |
| Advancement Flap | High or recurrent fistulas | Low — sphincter spared | 3–4 weeks |
Choosing the Right Procedure for Your Fistula
There is no single best fistula surgery. The right operation depends on the anatomy of your fistula, the amount of sphincter muscle it crosses, whether infection is active, and whether you have had previous surgery.
In many complex cases, treatment is staged. A seton is placed first to drain infection and mature the tract. Once the tract is healthy and well-defined, a definitive sphincter-preserving procedure — LIFT or advancement flap — is performed weeks or months later. Staged treatment significantly improves cure rates for complex fistulas without compromising continence.
This is not a decision patients should make on their own. After clinical examination and MRI (where needed), Dr. Gheewala will explain which procedure is right for you and why.
What to Expect on Surgery Day
Most fistula procedures are performed as day care or with one overnight stay. A typical day involves:
- Admission a few hours before surgery; light fasting overnight
- Pre-operative consultation with the anaesthetist
- Surgery under spinal or general anaesthesia (most procedures take 30–60 minutes)
- Recovery in the ward, with the first dressing checked before discharge
- Discharge the same day or the following morning with written wound-care instructions
Recovery & Aftercare
Recovery is straightforward when post-operative instructions are followed carefully:
- Pain is usually well controlled with oral medication for 3–5 days.
- Sitz baths in warm water 2–3 times daily keep the wound clean and ease discomfort.
- Light dressings are changed daily; Dr. Gheewala’s team will demonstrate how before discharge.
- A high-fibre diet and adequate hydration prevent constipation, which is critical for healing.
- Most patients return to desk-based work within 7–10 days; physically demanding work takes longer.
- Follow-up visits are scheduled to check wound healing and catch any early signs of recurrence.
Risks, Recurrence & How They’re Minimised
Like any surgery, fistula procedures carry some risk. The main concerns are recurrence of the fistula and changes to bowel control. Both risks are significantly reduced by:
- Accurate pre-operative imaging to map the tract
- Choosing the right procedure for the anatomy
- Staged treatment for complex fistulas
- Strict adherence to wound care and follow-up
About 80% of recurrences happen within six months of surgery, which is why follow-up visits are essential.
Why Patients Choose Dr. Husain Gheewala
- Specialist colorectal surgeon with two-year fellowship from York NHS Hospital, UK
- Hundreds of fistula procedures performed, including complex and recurrent cases
- MRCS — Royal College of Surgeons, Edinburgh
- Robotic surgery training from Severance Hospital, Seoul, South Korea
- Available across Saifee, Wockhardt, Apollo Spectra, Masina, Noor, Cumballa Hill, Elizabeth, and Conwest hospitals
- Patient-centred approach with detailed pre-operative counselling and continuous post-operative support
FAQs
Book Your Consultation
Anal fistula surgery is highly individualised — the right procedure for your fistula is the one matched to your anatomy. To book a consultation with Dr. Husain Gheewala