Anal fistula – assessment and referral

Typical symptoms

• Persistent or recurrent discharge of pus or blood near the anus.
• A small opening in the skin (fistula mouth) that weeps.
• Recurrent abscesses in the same area.
• Irritation, itching and odour.

Why we don't operate in the clinic

Treatment is planned individually from the fistula's anatomy and above all from how much of the sphincter it crosses. A superficial tract can be handled differently from one running through a substantial part of the sphincter, where the risk to continence is the decisive concern. Several techniques exist - laying open, seton, LIFT and advancement flap - and none of them is generally best for everyone. Treatment requires an operating theatre, so we refer onward to a colorectal department. We do not quote universal healing rates, because the outcome depends on fistula type, previous surgery and any underlying disease (ASCRS anorectal abscess and fistula 2022).

Our work-up at Kirurgen.dk

• Clinical examination by a specialist surgeon.
• Endoanal ultrasound or MRI when the tract is unclear, complex or recurrent.
• Assessment for underlying disease such as Crohn's, as treatment differs.
• Second opinion on existing diagnosis or treatment plan.

Referral – where do we send you?

We refer to a colorectal department in the Capital Region:

• Herlev Hospital – GI/Colorectal Surgery.
• Hvidovre Hospital – Gastro Unit.
• Bispebjerg Hospital – Department of Surgery.
• Hillerød (Nordsjællands Hospital) – Department of Surgery.
• Private hospital of your choice, if you have health insurance.

Assessment with us

You can be assessed with or without a referral. If you are in health insurance group 1 and have a valid referral from your GP, the examinations and treatments covered by the clinic's public health agreement are covered by the Danish public health insurance, so you pay nothing for them yourself. If you are in health insurance group 2, there is usually a small co-payment under the health insurance rules. If you are paying yourself, contact the clinic for a price. If you have an acute abscess with increasing pain, swelling or fever, you need same-day assessment through your GP, the out-of-hours helpline or an emergency department instead.