Skip to main contentLast updated: 18-Oct-2026
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 · 18 years of experience
★★★★★ Google rating 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)
In short
It can, but most do not. After a simple, low fistula is laid open, published studies find it returns in fewer than 1 in 10 people. The risk is higher when the tunnel is high, branched or has been operated on before. A careful map of the whole tunnel before surgery lowers it the most.
A fistula usually returns because part of the tunnel was left behind. The cause is most often a missed inner opening, a hidden branch or a pus pocket.
A fistula is a small tunnel. One end opens inside the back passage. The other end opens on the skin near the anus. The inner end is the source. It lets germs from the bowel into the tunnel again and again.
If the operation deals with the outer part but misses the inner opening, the tunnel fills again. The same is true of a side branch that nobody saw. This is why surgeons say a repeat fistula is usually a missed part, not a failed method.
Two other things can look like a return. A new abscess can form from a different gland, months or years later. And the skin can close over a wound too early, before the base has filled in. That traps fluid and the opening breaks down again.
The chance depends far more on the type of tunnel than on luck. Simple, low tunnels rarely return. High, branched or repeat tunnels return more often.
| Situation | What studies show | Why |
|---|---|---|
| Simple, low tunnel laid open | Fewer than 1 in 10 over several years | The whole tunnel is opened and heals from the base up |
| Loose seton removed with no second step | Often comes back | A loose seton drains the tunnel. It does not close it. |
| Loose seton with a planned second step | Similar to laying open, once the second step is done | The tunnel is treated after the infection settles |
| High, branched or horseshoe tunnel | Higher, and more so if a branch is missed | More hidden parts to find and treat |
| Muscle-sparing repairs at other centres | Around 2 in 10 or more | They protect the muscle, at the price of more returns |
| Crohn’s disease or tuberculosis | Returns until the disease itself is treated | The cause sits outside the tunnel |
Dr Shah does not do the muscle-sparing repairs listed above. He uses fistulotomy (laying the tunnel open) and the loose seton. When one of those other repairs suits a tunnel better, he says so and refers you.
Large studies keep finding the same few risk factors. The strongest is an inner opening that was never found at the operation.
Most of the work that prevents a return happens before the first cut. The tunnel is mapped, then every part is found and treated.
The full range of fistula care, and how the operation is chosen, is set out on the fistula treatment page.
Your part is to keep the wound clean, keep stools soft and keep every follow-up visit. Each one helps the wound heal from the base up.
Sit in warm water after each bowel movement and two or three times a day. Take fibre and a stool softener, with plenty of water. Hard stools and straining tear the healing wound.
Come to every wound check. At these visits the surgeon makes sure the skin is not closing over the wound before the base has filled in. If you have a seton, do not let the second step slide. A seton left with no plan is a common reason a fistula seems to come back.
If you have diabetes, keep your sugar under control. Healing is slower when sugar runs high.
A wet spot, discharge from the old scar or a new boil near the anus after the wound had healed can mean a return. It needs a fresh look.
Fever with a hot, swelling lump needs the emergency department the same day. Otherwise, book a visit. The usual next steps are a new MRI and an examination under anaesthesia, to find the missed part. A repeat fistula can still be treated. It is often a single missed opening or branch.
Every fistula operation balances two things. Cutting more muscle lowers the chance of a return but puts bowel control at risk. Cutting less protects control but may mean a second stage. Dr Shah explains where that balance sits for your tunnel before you decide. Our piles, fissure and fistula clinic page shows how the four common back-passage problems differ.
It can, but most returns show up within the first year. A problem years later is often a new abscess from a different gland, not the old tunnel.
It needs more care, because scar tissue hides the path. An MRI before the next operation is advised, so the missed part can be found.
A loose seton drains the tunnel and protects the muscle. It does not close the tunnel by itself, so a second step is planned.
No. They settle infection for a while, but they cannot close the inner opening. Tuberculosis is the exception, where TB medicines are the treatment.
The wound is closed, dry and flat, with no discharge for several weeks. The surgeon confirms this at the follow-up visits.
Diet does not close a tunnel. But soft stools protect the healing wound, and good sugar control helps it heal.
For questions before you travel, call +91-63555-64601.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
SF-203, 2nd Floor, Olive Greens, Gota, Ahmedabad.
Consultation, MRI reading, planning of surgery, and wound checks until healing.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Examination under anaesthesia, fistulotomy, seton and abscess drainage, with a short stay.
Worried that your fistula will return, or has it already come back once? Any MRI and earlier operation notes can be sent ahead on WhatsApp, so they are read before the visit. The plan is made after examination. Call +91-63555-64601 Send reports before your visit
Swasth Parivar: twice a month, practical advice on recovery, diet and warning signs. No advertising. Stop any time.
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