Skip to main contentDr Harsh Shah · GI & Proctology Surgeon · Ahmedabad & Gandhinagar
Last updated: 18-Oct-2026
Fistula treatment in Ahmedabad · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
In short: a fistula-in-ano, or bhagandar, is a small tunnel from inside the back passage to the skin near it. It almost never heals with tablets alone. Dr Harsh Shah first maps the track with an examination and, when needed, an MRI fistulogram.
He then offers one of two operations. A low, simple fistula is laid open (fistulotomy). A high or complex one gets a loose seton, a soft thread that drains the infection and protects the control muscle, with a planned second stage later.
Every plan balances two things: the chance of the fistula coming back, and the chance of weaker bowel control.
A fistula usually starts as a pus boil (abscess) from a tiny gland inside the anal canal. When the boil bursts or is drained, a lined tunnel can stay behind and keep leaking.
Dr Harsh Shah has 18 years of experience in gastro and bowel surgery, including surgery of the anus and back passage. For fistula, he examines you himself, reads the MRI with you, does the examination under anaesthesia, and follows the wound until it has healed.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
GI & Proctology Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Google rating 4.89 from 216 reviews at the Gota clinic, and 4.94 from 18 reviews at Apollo, Bhat.
The inner opening sits inside the anal canal. The outer opening is the pimple-like spot on the skin that leaks pus or staining. Between them, the track runs through or around the ring muscles that hold stool in, the sphincter muscles. The outer opening often closes for a few weeks, then pus collects and it bursts again. Roughly one in six people with a first anal abscess go on to form a fistula.
Antibiotics calm the redness and pain for a while. They cannot remove the lined tunnel or close the inner opening, so the infection returns once the course ends.
The lining stops the tunnel from closing, and the inner opening keeps letting bowel germs in. That is why repeated courses of tablets, creams or powders end with the same boil. Antibiotics still help with spreading redness, fever, diabetes or low immunity. But the cure is to deal with the track itself. A hot, painful lump is an abscess. It needs drainage under anaesthesia, not another course of tablets. Our perianal abscess drainage page explains that step.
Surgeons group fistulas by how the track runs through the sphincter muscles, called the Parks types. A track that crosses little muscle is simple. A track that crosses a lot of muscle, branches or recurs is complex.
| Type (Parks) | Where the track runs | Simple or complex | Usual plan |
|---|---|---|---|
| Superficial | Just under the skin or lining. No sphincter muscle crossed. | Simple | Fistulotomy |
| Intersphincteric | Between the inner and outer ring muscles, low down. | Usually simple | Fistulotomy, if control is good |
| Low transsphincteric | Through the lower part of the outer muscle only. | Simple in a man with good control and no earlier surgery | Fistulotomy, after MRI and examination |
| High transsphincteric | Through the upper part of the outer muscle. | Complex | Loose seton, staged plan |
| Suprasphincteric | Goes up and over the whole outer muscle. | Complex | Loose seton, staged plan |
| Extrasphincteric | Outside the whole muscle ring, from higher up. | Complex | Loose seton, and a search for a cause higher in the pelvis |
Some features make any fistula complex: a front-facing track in a woman, a fistula that has come back, more than one opening, a horseshoe track around both sides, weak control before surgery, and Crohn’s disease. Complex does not mean hopeless. It means cutting muscle is not the first answer.
Examination alone gets the track right only about six times in ten. MRI gets it right about nine times in ten in published studies, and it shows hidden branches and pus pockets that cause recurrence.
An MRI fistulogram is a pelvic scan taken in special planes along the anal canal. No dye is pushed into the opening. Dr Shah asks for it when a fistula has come back, has more than one opening, sits at the front in a woman, feels deep, or may be linked to Crohn’s disease.
Cutting more muscle lowers the chance of the fistula returning but raises the risk of weaker control of gas or stool. Cutting less protects control but may need more than one stage. Your track decides where the balance sits.
| Fistulotomy (lay-open) | Loose seton, staged | |
|---|---|---|
| Who it suits | Low, simple tracks that cross little muscle, with good control | High or complex tracks, women with front-facing tracks, Crohn’s, weak control |
| Muscle cut | Only the small part below the track | None at the first stage |
| Chance of coming back | Low; fistulotomy is the most reliable single cure for a simple track | Higher if the seton is simply removed; a second stage is planned for that reason |
| Bowel control | Minor leakage of gas or staining can occur; major loss is uncommon in a simple fistula | Protected while the seton is in |
| Number of operations | Usually one | Two or more, weeks apart |
| Healing | Open wound heals in about 4 to 8 weeks | Seton is comfortable within days; final healing depends on the second stage |
Dr Harsh Shah explains both sides with your MRI in front of you, and you take part in the choice.
Examination under anaesthesia (EUA) is a short check in the operating room while you are asleep or numb from the waist down. The track is confirmed, and the planned operation is done in the same sitting.
You consent beforehand to that change of plan. Tissue and pus are sent for testing, including for tuberculosis.
Fistulotomy opens the whole tunnel along its length so it heals from the bottom up as a shallow groove. For a simple track it is the most reliable single cure.
A fine probe is passed along the track. The skin and the small amount of muscle below it are divided, and the lining is scraped clean. The wound edges are stitched to the floor of the track (marsupialisation), which shortens healing. The wound is left open on purpose, because a closed wound over an infected track would bring the fistula back. It is usually a day-care or overnight operation under spinal anaesthesia.
A loose seton is a soft silicone thread passed through the track and tied loosely outside. It keeps the track draining, settles the infection and cuts no muscle. It is the safest first step in a complex fistula.
A loose seton is never tightened, unlike a cutting seton. Removing it without a second-stage plan often lets the fistula return, so the plan is written down before you go home.
Other centres offer muscle-sparing repairs and device-based treatments. Dr Shah does not offer them. He keeps to EUA, fistulotomy and loose seton, and refers you if another method suits your track better.
| Option | What it is | With Dr Shah |
|---|---|---|
| LIFT | The track is tied and divided in the space between the two muscles, sparing the muscle. | Not offered by Dr Shah; referral if it suits your track |
| Advancement flap | A flap of bowel lining or skin is moved to cover the inner opening. | Not offered by Dr Shah; referral if it suits your track |
| VAAFT | A thin camera passed along the track to clean and seal it. | Not offered by Dr Shah |
| Laser (FiLaC) | A laser fibre passed along the track to seal it with heat. | Not offered by Dr Shah |
| Glue or plug | The track is filled with surgical glue or a plug of material. | Not offered by Dr Shah |
| Kshara sutra | A traditional medicated thread that works as a slow cutting seton, changed weekly. | Not offered by Dr Shah |
If you arrive with a thread or seton already in place, Dr Shah reviews the MRI before anything is changed.
Some fistulas have a cause beyond a blocked gland. Crohn’s disease needs joint care with a gastroenterologist, and tuberculosis needs anti-TB medicines. Surgery alone does not cure either.
| Situation | What is different |
|---|---|
| Crohn’s disease | Pus is drained and a loose seton placed. Medical treatment by a gastroenterologist does the main work. Fistulotomy is avoided if the back passage is inflamed. |
| Tuberculosis | Several openings, thin watery discharge or repeated return after surgery raise the question. Tissue tests confirm it, and anti-TB medicines heal it. |
| Front-facing track in a woman | The muscle there is short. Muscle cutting is kept to the most superficial fibres, and a seton is favoured. |
| Diabetes or low immunity | Sugar control first, and a lower threshold for a seton. |
| Bleeding from the back passage | A fistula rarely causes real bleeding. Bleeding is checked for other causes, with a colonoscopy in the right patients. |
| A track present for many years | A long-standing track whose discharge or pain changes is sampled and sent for testing. |
The first few days are sore; pain is controlled with tablets, sitz baths and stool softeners. Most people go home the same day or the next morning, and return to desk work within a week.
| When | Fistulotomy | Loose seton |
|---|---|---|
| Days 1 to 3 | Sore, especially with the first bowel movement. Regular tablets, softeners and sitz baths. | Mild soreness. The thread feels odd at first. |
| Days 4 to 7 | Soreness easing. Light discharge on the pad is normal. | Back to desk work. |
| Weeks 1 to 2 | First wound check. Back to desk work if not already. | Check that the seton is loose and draining. |
| Weeks 4 to 8 | The wound closes from the bottom up. Manual work when sitting and walking are easy. | Planning for stage two. |
Come back at once with any of these.
Keep the wound clean with sitz baths, keep stools soft, and use a light pad. The wound is not packed at home, because packing hurts and does not speed healing of a laid-open track.
Fistula surgery is common and usually safe, but it has real risks. The main ones are the fistula coming back and some weakening of bowel control. Both are discussed in person before consent.
Fistulotomy: minor leakage of gas or staining, lasting in some people. Major loss of stool control is uncommon after a simple fistula. The fistula can come back. Bleeding in the first days, difficulty passing urine after spinal anaesthesia, wound infection, slow healing in diabetes, and skin bridging over the wound too early.
Loose seton: irritation and discharge around the thread, a new pus pocket, the seton slipping out, and a second anaesthetic for stage two.
General risks: anaesthetic problems, clots in the legs, and chest or heart problems in older people. Dr Harsh Shah goes through each of these in person before consent, with the figures that apply to your track.
The estimate depends on whether an MRI is needed, which operation is done, and whether one or two stages are planned. A staged seton plan means two admissions.
Apollo Hospital, Bhat, works with the major insurers and cashless schemes, and the office handles pre-authorisation. Bring: MRI and blood reports, earlier operation notes, a list of medicines, the insurance card and identification. You can also call +91-63555-64601 to ask what to bring.
Rarely. Antibiotics settle the swelling for a while, but the lined tunnel and the inner opening stay. Tuberculosis is the main exception, where anti-TB medicines are the cure.
For a fistula that has come back, has more than one opening, sits at the front in a woman, or feels deep, yes. It finds hidden branches and pus pockets that cause the fistula to return.
Neither is better for everyone. Fistulotomy suits a low track that crosses little muscle. A loose seton suits a high or complex track, where cutting the muscle would risk bowel control.
Major loss of control is uncommon after a simple fistulotomy. Minor leakage of gas or staining can occur. A seton is chosen when the track crosses enough muscle to make that risk too high.
An open fistulotomy wound usually heals in about 4 to 8 weeks. Stitching the edges to the track floor shortens this. Most people return to desk work within a week.
Usually 6 to 12 weeks before the second stage. In Crohn's disease or in frail patients it may stay longer. It is loose, so it does not cut the muscle.
No. Dr Shah does not offer laser, VAAFT, LIFT, flaps, glue or plug. He offers EUA, fistulotomy and loose seton, and refers you if another method suits your track better.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
SF-203, 2nd Floor, Olive Greens, Gota, Ahmedabad.
Consultations, review of MRI fistulograms, planning of surgery, and wound follow-up.
Google: Dr Harsh Shah · 4.89 from 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Google: Dr Harsh Shah – Robotic GI Surgeon · 4.94 from 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Patients come to Ahmedabad from across Gujarat, including Gandhinagar, Mehsana, Nadiad, Anand, Rajkot and Kutch, and from southern Rajasthan.
A boil near the anus that keeps bursting, or a wet, itchy opening that stains your underwear? Send your MRI fistulogram and earlier operation notes ahead, so they are read before you arrive. Fever with a hot, swelling lump near the anus needs the nearest emergency department today. Call +91-63555-64601 · Send the MRI and reports on WhatsApp
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