Surgical management is the usual therapy. The goal of surgical therapy is to eradicate the fistula while preserving fecal continence. The surgical approach depends upon the type of fistula. We can cut open the fistula to have it heal from the inside out or use a laser to seal it from the inside. Laser fistulotoplasty is not covered by provincial health insurance.
Whereas simple fistulas do not require imaging to guide treatment, complex fistulas, especially those associated with perianal Crohn disease, and recurrent fistulas can benefit from imaging studies. Magnetic resonance imaging (MRI) and ultrasound are the preferred imaging studies to determine the anatomy of the fistula tract and the extent of anal sphincter involvement.