Fistula Doctor in Pune — Dr. Kundan Kharde, MS FMAS (19+ Years, 6,000+ Surgeries)

What is an anal fistula, and how does it show up?

An anal fistula is an abnormal passage between the anal canal (or occasionally the rectum) and the skin around the anus. It usually forms after a perianal abscess drains or is drained, leaving a tunnel lined with inflammatory tissue. Common associations are previous abscess surgery, Crohn’s disease, tuberculosis in endemic settings and, rarely, malignancy or radiation injury. Because the tract may pass through the sphincter muscles that control continence, treatment must balance complete healing with preservation of function.

Symptoms that point to a fistula

• Persistent pain or throbbing around the anus, worse on sitting
• Pus or blood-stained discharge from a small opening near the anus
• Swelling, redness or tenderness that comes and goes
• Recurring anal abscesses, sometimes with fever
• Irritated, wet or itchy skin around the external opening

These overlap with piles and fissure, and misdiagnosis online is common — see fistula vs piles. If a fistula has already been operated on once or more, read how I approach complex and recurrent fistula — fresh MRI re-mapping, why the last operation failed, and a staged sphincter-preserving repair.

Fistula surgery techniques compared — FiLaC, VAAFT, LIFT, seton, fistulotomy

The table shows how the five operations differ in what they suit, what they risk and how long they take to recover from. Recurrence figures are pooled ranges from the published literature cited under the table — they are not a promise for your fistula, which depends on its depth, branches and whether it has been operated on before.

Sources: Elfeki H et al., Colorectal Disease 2020 (FiLaC systematic review); Garg P & Singh P, International Journal of Surgery 2017 (VAAFT systematic review); Hong KD et al., Techniques in Coloproctology 2014 (LIFT systematic review); Ritchie RD et al., Colorectal Disease 2009 (cutting seton systematic review); Gaertner WB et al., ASCRS Clinical Practice Guideline, Diseases of the Colon & Rectum 2022. Ranges are pooled published outcomes, not an audited personal series.

In practice I often combine them: a proximal fistulotomy for the superficial part with FiLaC for the segment crossing the sphincter, or a draining seton first and a definitive procedure weeks later. Detailed comparisons: FiLaC vs fistulotomy, laser vs open surgery, and VAAFT vs open on the blog.

Types of fistula I treat

Fistulas are classified by their relationship to the sphincter complex (Parks classification) and by complexity — simple versus complex, recurrent, horseshoe. The type decides which row of the table above applies.

High or horseshoe tracts and fistulas that have come back after one or more operations behave differently: the internal opening is harder to find, scarring distorts the anatomy, and repeating the same operation usually fails the same way. These cases are planned on a fresh MRI, with Crohn’s disease and tuberculosis excluded where indicated — see complex and recurrent fistula treatment.

A recent case: one MRI, one plan, no guessing

A patient came to me with a discharging opening at the 4 o'clock position, and the MRI fistulogram showed a trans-sphincteric tract running from there to an internal opening at 6 o'clock, crossing the external sphincter on the way. In theatre the probe followed exactly the path the scan had drawn, so there was no hunting for the internal opening and no surprise branch. I laid open the proximal, superficial part of the tract with a fistulotomy and closed the segment passing through the external sphincter with FiLaC laser, so the muscle itself was not divided. That is what imaging buys: one map, one plan, and a sphincter left intact.

Read the full case on the Sharvari Hospital site →
How I map a fistula on MRI →

Your fistula care pathway, step by step

1. Consultation and examination: history, examination and usually proctoscopy to find external openings and assess continence. Bring prior MRI or operative notes if treated elsewhere.
2. Imaging before surgery: an MRI fistulogram or trans-rectal ultrasound in almost every case. The scan shows the internal opening, how much sphincter the tract crosses and any hidden branch — and that decides between a lay-open and a sphincter-preserving plan.
3. Plan discussion: which technique and why, realistic recurrence risk, time off work and the cost band, before you consent.
4. Day-care or short-stay surgery: 30–60 minutes under spinal or general anaesthesia in a sterile OT; same-day discharge is usual for simple and moderate tracts.
5. Follow-up: wound review at one, two and four weeks, written aftercare, and a direct line for red-flag symptoms.

Fistula surgery cost in Pune and insurance

In private hospitals in Pune, fistula surgery commonly falls between ₹40,000 and ₹1,20,000, depending on complexity, technique (laser, LIFT, VAAFT, staged seton), anaesthesia, room category and length of stay. Recurrent, horseshoe and Crohn’s-related fistulas that need staged procedures sit at the higher end. Medically necessary fistula surgery is commonly admissible under standard health policies; cashless treatment depends on your insurer’s tie-up with the hospital, and reimbursement claims are filed with the discharge summary, bills and operative notes.

Full breakdown: fistula surgery cost in Pune. A written estimate follows examination — book by phone, WhatsApp or the contact page.

When is a fistula an emergency?

Seek same-day attention for spreading redness, high fever, rigors, a rapidly enlarging painful swelling, difficulty passing urine or heavy bleeding — these point to an abscess or severe infection that needs drainage, not a routine clinic slot. A stable chronic fistula with intermittent discharge is rarely an overnight emergency, but it still deserves timely planning to stop the abscess cycle. If unsure, call +91 951 951 1928 so staff can triage.

Myths versus facts

Recovery after fistula surgery

Typical timelines for uncomplicated laser or limited procedures — your discharge sheet is the authority for your case.

1. Day 0–2: rest, prescribed pain relief, sitz baths twice daily, light high-fibre diet.
2. Day 2–5: most desk workers resume work; avoid long sitting without breaks.
3. Week 2–4: wound granulates; follow-up checks at one, two and four weeks.
4. Week 4+: gym, cycling and heavy lifting only when cleared.

Call the same day for fever, increasing pain, heavy bleeding, inability to pass urine or spreading redness. Related reading: fistula recovery time, why fistulas don’t heal (FRIENDS) and non-surgical options — an honest overview.