Here are the most common reasons why an anal fistula may recur:

Incomplete Treatment of the Fistula Tract:

One of the most common causes of recurrence is insufficient removal or treatment of the fistula tract during surgery. If any part of the infected tissue is left behind, the infection may persist or reoccur, forming another fistula.

Some fistulas are complex with multiple branches, and if the surgeon misses even a small branch, it can lead to recurrence. This is why expert evaluation and precise imaging (like MRI or fistulograms) are crucial before surgery.

Complex or High Fistula Anatomy:

Fistulas vary in complexity. High anal fistulas or horseshoe-shaped fistulas that wrap around the anus are harder to treat.

Such fistulas are more likely to recur due to:

• Difficulty accessing the full extent of the tract
• Risk of damaging anal muscles during surgery
• Multiple hidden side branches

Incorrect or Outdated Surgical Technique:

Not all fistulas can be treated with the same technique. For example, simple low fistulas may be successfully treated with fistulotomy, but complex or recurrent ones need advanced procedures like:

• VAAFT (Video-Assisted Anal Fistula Treatment)
• LIFT (Ligation of Intersphincteric Fistula Tract)
• Fistula Plug
• Laser treatment (FiLaC)

Choosing an improper surgical method, specifically by a surgeon with limited experience in complex fistulas, can result in persistent or recurring fistulas.

Presence of an Unrecognized Internal Opening:

Every anal fistula has an internal opening inside the anal canal through which stool or bacteria can enter and reinfect the tract. If the internal opening is not identified and closed during treatment, ongoing contamination will cause the fistula to recur.

At Kaizen Fistula Care Clinic, Dr. Samrat Jankar uses advanced imaging and diagnostic tools to precisely identify the internal opening and treat it effectively.

Underlying Conditions Like Crohn’s Disease:

In some patients, recurrent fistulas are a sign of underlying diseases such as Crohn’s disease, a chronic inflammatory bowel disease. In such cases, unless the root cause (inflammation of the intestines) is treated, the fistulas will continue to return.

Other medical conditions associated with recurrent fistulas include:

• Tuberculosis
• Diabetes (which slows wound healing)
• HIV/AIDS or other conditions that suppress immunity

A detailed medical evaluation is essential to detect such conditions early.

Post-Surgical Infection or Poor Wound Care:

Even after a successful surgery, postoperative care is required. If the wound becomes infected after surgery or isn’t cared for properly, it can lead to the development of another abscess, leading to a new or recurring fistula.

Maintaining good hygiene, attending follow-ups, and taking prescribed medications are all important to prevent recurrence.

Previous Failed Surgeries:

Patients who’ve had multiple surgeries for fistula may develop scar tissue, muscle damage, or distorted anatomy in the anorectal region. This can make future surgeries more difficult and increase the risk of recurrence. That’s why it’s important to seek care from a specialist with advanced experience in recurrent and complex cases.