What is advancement flap surgery?

An advancement flap procedure is a surgical treatment for anal fistulas. It involves creating a small flap of tissue from the anus or lower rectum to cover the internal opening of the fistula. This helps to close the fistula while preserving the surrounding muscles. The procedure may sometimes be combined with other treatments, such as a fistula plug or paste.

Why might you need this procedure?

You may be advised to have an advancement flap procedure if you have an anal fistula that:

• Is causing ongoing symptoms such as pain, discomfort, or discharge

• Has not healed with other treatments, such as seton drainage

• Is in a position where other types of fistula surgery may risk damaging the anal sphincter muscles, leading to incontinence

Your consultant will discuss your individual case and recommend the most suitable treatment for you.

What does the operation involve?

• You may need an enema about an hour before the procedure to clear the lower part of your bowel

• The operation is performed under general anaesthetic and usually done as a day case, meaning you can go home the same day

• The surgeon will examine your anus and identify the fistula track

• If a seton drain has been placed previously, it will be removed

• A flap of healthy tissue from inside the anus or rectum is carefully raised

• The fistula track is cleaned and the inner opening is stitched closed

• The flap is then placed over the closed opening and stitched in place

• The outer opening of the fistula is usually left open to allow drainage

• A simple dressing will be applied to the area after surgery

The procedure takes around 45 minutes to complete.

What are the risks?

As with any surgery, there are some risks, but serious complications are rare.

• Bleeding – Some minor bleeding is normal, but heavy bleeding should be reported to your doctor

• Infection – There may be some discharge from the wound, which is expected, but increased pain, swelling, or fever should be checked

• Blood clots – If you are staying overnight, you may be given small injections to prevent thrombosis (blood clots)

• Flap failure – In some cases, the flap may not heal properly, and further treatment may be needed

• Recurrence – Some fistulas may return and require further surgery

Your consultant will explain these risks in detail before your procedure.

What happens after the operation?

• The procedure is not usually very painful, and simple painkillers can help manage discomfort

• You will be given a stool softener to make bowel movements easier and to prevent straining

• It is important to keep your bowels moving, even if it feels uncomfortable at first

• You will be seen in clinic for follow-up appointments to check healing

• You may have some discharge from the wound, which is normal and should settle over time

• You should avoid heavy lifting and strenuous activity for a few weeks

For more advice on caring for yourself after fistula surgery, please refer to our aftercare guide for anal surgery.

Why choose the Midlands Bowel Clinic?

At Midlands Bowel Clinic, we provide expert colorectal care with a patient-centred approach. Our highly experienced specialists use the latest techniques to ensure the best possible outcomes. We offer:

• Expert fistula care with personalised treatment plans

• Minimally invasive surgical techniques to promote faster healing and reduce discomfort

• Comprehensive aftercare to support your recovery

• Access to top colorectal consultants with no long waiting times

Contact us

If you have any questions about your condition or treatment options, please get in touch. Our team is here to support you.