Fistula Treatment in Karachi – By Dr. Abdullah Iqbal

Hello, my name is Dr. Abdullah Iqbal, a consultant colorectal and laser surgeon based in Karachi.
Every week I meet patients who are silently suffering from a problem called anal fistula (bhagandar). Many of you delay help because you feel shy or you hope it will heal on its own. I want to tell you – you don’t need to live with this pain or discharge. With proper diagnosis and the right treatment, you can get back to a normal life.

I trained in general surgery, then specialised in colorectal surgery and laser proctology. Over the years I have performed more than ten thousand successful operations for hemorrhoids, fissures and fistula. Many of these were complex and high-lying fistula. If you are looking for the best doctor to treat your fistula in Karachi, my team and I at Hill Park General Hospital are here to help.

What is Anal Fistula?

A fistula is like a small tunnel under your skin. It runs between the inside of your rectum or anal canal and an opening on the skin near your anus. Most people develop it after an anal abscess (a pocket of pus). Around half of abscess cases later form a fistula.
Sometimes it starts slowly without an abscess. The main sign is a hole or spot near the anus that keeps draining pus, blood, or smelly fluid. A fistula will not go away with only tablets or creams. The tract has to be cleared or closed properly.

Types of Fistula in Ano

There are multiple types of fistula, we classify fistulas based on their relationship to the anal sphincter muscles that help you control your stool. Understanding your specific type helps determine the best treatment approach I can take for your treatment.
This is done with the help of MRI, through this investigation, I check which muscles the tract crosses.

• Intersphincteric – This type of fistula runs between the inner and outer muscle layers; most common.
• Transsphincteric – This type of fistula passes through part of the outer muscle.
• Suprasphincteric – This type of fistula curves high above the muscle before coming out.
• Extrasphincteric – This type of fistula is very rare; usually after injury or bowel disease.

These names sound technical but they help decide which technique gives best healing with least risk of loosing control on your bowel.

Simple vs Complex Fistula

Another way to categories fistula is based on the size of the tract, number of openings and history of previous treatment. In this way we divide fistula in either simple or a complex one.
Simple Fistula: A simple fistula is usually low and crosses little or no muscle (less than one-third). Thus, all intersphincteric fistulas are simple fistula. Low transsphincteric fistulas involving less than 30% of the external sphincter are also simple fistula

Complex Fistula: A complex fistula is usually a high lying fistula or big fistula. Also, if it involves any of the following features it is also considered as complex fistula

• Involves more than 30% of external sphincter
• Comes again after earlier surgery
• Has many branches or horseshoe shape
• Is linked with any underlying disease such as Crohn’s disease, tuberculosis, previous radiation, or incontinence
• In women, front-side fistulas are also considered complex because sphincter muscle here is small.

I always check if your case is simple or complex so I can explain clearly which method is safest for you.

Symptoms That Bring Patients to Me

If you’re reading this, you might already be suffering fistula or may be trying to find out if you really suffering from it.  I understand what you’re dealing with, and I can help you to reduce your anxiety and encourage you to seek treatment.

• Pain and swelling near the anus, worse when sitting
• Pus, blood, or yellow discharge from a small opening
• Skin irritation and itching around anus
• Pain while passing stool
• Feeling feverish or tired if infection is present
• A small bump that bursts, giving relief but then comes back

If you see these signs again and again, book an appointment. Early care avoids big surgery later.

What Causes Fistula?

Its important for you to understand what causes the fistula you have. This can help you not only in understanding and treating the underlying cause but also will prevent you from having the same problem in future.

Blocked Anal Glands: The most common cause is when small glands inside your anal canal become blocked and infected. These glands normally produce mucus to help with bowel movements, but when blocked, they can form abscesses that eventually create fistula tracts.

Previous Anal Abscesses: If you’ve had an abscess that wasn’t properly drained or treated, it might have formed a fistula as your body tried to create a path for the infection to drain.

Other causes include:

• Irritable bowel syndrome
• Inflammatory bowel disease such as Crohn’s disease
• Radiation for pelvic cancers
• Injuries, obstetric tears, or previous anorectal surgery
• Sexually transmitted infections
• Tuberculosis
• Rarely, rectal or anal cancer can also lead to formation of fistula in ano

When I take your history I also look for bowel symptoms, weight loss, or past illness.

Diagnosis at My Clinic

At my clinic, I examine you gently, using a gloved finger, in a private setting. I look for the external opening, I check for pus draining from your opening or look for any swelling, I feel for a cord under skin, and check inside with a small scope (anoscope).

For hidden or branching tracts I order an MRI fistulogram. It gives a clear map of length, depth, and relation with muscles. Sometimes, if I suspect any underlying disease such as irritable bowel syndrome, I order colonoscopy or may suggest you some blood tests.

Remember: The diagnostic process is thorough because accurate mapping of your fistula is what allows me to choose the most appropriate treatment method and achieve the best possible outcome.

Fistula Treatment Options in Karachi

Fistula never heals without surgery. The goal of any fistula treatment is to heal the abnormal connection while preserving your ability to control your bowel movements. The approach I recommend depends on several factors including the type of fistula, your overall health, and your personal preferences.

While doing the surgery, my aim is to clean or close the tract while making sure all branches of fistula are properly dealt and the disease completely heals as quickly as it can.

At our clinic we use both standard and laser-assisted methods. Healing time depends on size and type, but most wounds close in 2–4 weeks with proper care.

Key points we talk about:

• Pain – modern techniques and laser help keep pain mild.
• Bleeding – small oozing is common; heavy bleeding is rare.
• Wound care – you need good hygiene and sitz baths.
• Recurrence – careful surgery and follow-up lower the chance of coming back.
• Continence – we try to keep your muscles intact.

1. Fistulotomy

I open the tract along its length so it heals as a flat scar. It is simple and has highest success for low fistulas. Not safe if too much muscle is involved.

2. Fistulectomy with Laser

I remove the tract completely and use laser energy to seal edges, which limits bleeding and speeds healing.

3. LIFT (Ligation of the Intersphincteric Fistula Tract)

Good choice when fistula crosses the muscle. I tie the inner part and clean the rest without cutting muscle. I also perform Laser-assisted LIFT for better closure.

4. FiLaC (Fistula Laser Closure)

A soft laser probe is passed inside the tract, delivering heat that shrinks and seals. No external cut, quick recovery.

5. VAAFT (Video-Assisted Anal Fistula Treatment)

I insert a thin scope to see inside, burn the tract from within, and stitch the inner opening. Skin remains intact. Recurrence is higher (about 3 in 10) but good for selected complex cases.

6. Fistula Plug

A bio-absorbable plug is placed inside tract; body grows tissue over it. Nearly painless, but may slip or get infected.

7. PILTEC

A technique I use for very complex fistulas. It is based on LIFT but with added laser steps. I learned it from international experts and have good success even with branching tracts.

One-Stage vs. Two-Stage Procedure in Fistula Treatment

When it comes to treating a fistula (bhagandar), the choice between a single-stage or two-stage approach depends on how simple or complex your tract is.
One-Stage Procedure

• Ideal for simple, low fistulas with a single straight tract.
• The tract is treated in one sitting, usually with FILAC (Fistula Laser Closure) or a combination of laser and minimal excision.
• Healing is faster, and post-operative pain is minimal when high-quality laser fibers are used.

Two-Stage Procedure (For Complex Fistulas)

If your fistula is high, has multiple branches, or involves the sphincter muscles, I recommend a two-stage plan for safety and better results:

1. Seton Placement:

• A special thread (seton) is placed in the tract.
• Depending on your case, this can be a draining seton (to keep the area dry and infection-free) or a cutting seton (to gradually divide deeper tissue without damaging the muscle).
• This stage prepares the tract and protects the anal sphincter.

2. Second Stage – FILAC (Laser Closure):

• After the area settles, I perform laser closure of the tract using a precision fiber.
• Laser energy seals the internal lining, reduces infection risk, and preserves continence.

Using laser in both stages gives superior results, less pain, and faster return to routine activities compared to conventional surgery.

Why Choose Laser Treatment for Your Fistula?

• Precision: Laser energy can be controlled with millimeter precision, allowing me to treat your fistula while protecting healthy surrounding tissues.
• Reduced Pain: Laser procedures typically result in significantly less post-operative pain compared to traditional surgical methods.
• Faster Healing: The laser’s energy promotes better blood circulation and accelerates the natural healing process.
• Lower Infection Risk: The laser’s heat has antimicrobial properties, reducing the risk of post-operative infections.
• Minimal Scarring: Laser procedures create less scar tissue, which means better cosmetic results and reduced risk of future complications.
• Outpatient Procedure: Most laser fistula treatments can be performed as day surgery, allowing you to return home the same day.

Cost of Fistula Surgery in Karachi

The price for advanced laser fistula (bhagandar) surgery with Dr. Abdullah Iqbal usually ranges between 130,000 to 250,000 PKR.
The final amount depends on several key points, such as:

Factors That Influence the Cost

Type & Complexity of Fistula:

Simple, low fistulas are less expensive to treat, while complex, high tracts or horseshoe fistulas need more precision and time.

Single-Stage vs. Two-Stage Procedure:

Most cases can be managed in a single sitting, but if your fistula is high or has multiple branches, a two-stage approach may be required — this can increase the overall cost.

Hospital Charges:

Prices vary between hospitals in Karachi depending on their service quality, operation theatre facilities, and post-operative care.

Room Preference:

Day-care or ward admission is most common, but if you choose a private or deluxe room, your bill will be higher.

Anesthesia & Theatre Setup:

General or spinal anesthesia, and the type of monitoring required, also influence the amount.

Importance of Fiber Quality

One of the biggest expenses in laser fistula treatment is the special laser fiber. This fiber has a very limited life (usually single-use) and is very expensive, forming around 60% of the total surgical cost. At our centre, we ensure every patient receives a high-quality fiber, giving you the safest and most effective result.

Open Fistula Surgery (Traditional)

If you prefer a conventional approach, open fistula surgery in Karachi generally costs 70,000 to 80,000 PKR.
However, recovery time, pain, and wound care are usually higher with open techniques compared to modern laser procedures..

Why Fistulas Come Back

Recurrence happens if:

• The primary tract or a branch is missed
• Infection continues due to poor drainage
• Patient has Crohn’s or TB not treated
• Scar tissue makes new path

That is why I always say: proper MRI, full surgery, and careful after-care matter as much as the operation itself.

Aftercare – How You Heal Well

• Take sitz baths (warm water + antiseptic) 15–20 minutes, 2–3 times daily and after stool
• Wash with water instead of rough tissue
• Apply ointment gently as advised
• Eat soft fibre food: papaya, apple, vegetables, daal
• Drink 10–12 glasses of water; in Karachi summer take more
• Use stool softener at night for few weeks
• Avoid heavy exercise until wound closes
• Call me if you get strong pain, high fever, or heavy bleeding

Most patients return to routine in 3–5 days, though full healing may take few weeks.

Why Choose Dr. Abdullah Iqbal for Fistula Surgery in Karachi – Importance of Choosing the Right surgeon

• Focused practice in anorectal diseases: piles, fissure, fistula
• Over 1,000 laser procedures with high success, each year.
• I am one of the leading practitioner of laser fistula surgery in Karachi, I’ve seen firsthand how this technology transforms patient outcomes
• Hospital located near Shahid-e-Millat Road, easy from Bahadurabad & Tariq Road
• We follow international-standards and high end laser technology.
• Our instruments are imported and of highest quality available across the globe
• Personal follow-up: I see every patient myself till they heal

Living With Fistula – Don’t Ignore It

Fistula is not only a small hole. It is an ongoing infection that can spread or cause abscess, if you leave it untreated. Some people keep draining pus for years, which affects work and family life.
If you feel shy to talk, remember I see these problems every day. My clinic keeps full privacy. Treating fistula early saves you from bigger surgery later

FAQ’s