Definitive Rx (several options are there, they are)

• doing nothing
• conversion to a cutting Seton
  
• lay-open of fishila -in - ano
• fibrin flue infection
• fishila plug
• endorectal advancement flap.
• anal fistula plug

Doing nothing
A drainage section can be left in place long term to prevent problems. Safest option although it does not definitely cure the fistula.

Conversion to a cutting Seton
This involves a similar process to a draining seton but the suture is tied tightly. This gradually cuts through the muscle and skin involved, leaving behind a small area of scarring. This cures the fistula but leaves behind a scar and cause problems with incontinence. This option is not suitable for complex fistulae, or those that cross the entire anal sphincter.

Lay open of fistula - in - ano;
This option involves an operation to cut the fistula open and let it heal naturally. This cause the fistula but leaves behind a scar, and cause problems with incontinence. This option is not suitable for complex fistulae or those that cross the entire anal sphincter.

Fibrin glue infection:
Fibrin glue infection is a method explored in recent years with variable success. It involves injecting the fistula with a biodegradable give which should in theory, close the fistula from the inside out and let out heal naturally. It avoids the risk of incontinence and creates minimal stress for the patient.

Fistula Plug:
Fistula plug is an "advanced" version of the fibrin glue method. It involves "plugging" the fistula with a plug made of porcine small intestine sub mucosa (sterile biodegradable) fixing the plug from inside of the anus with suture, and again letting the fistula heal "naturally" from the inside out. According to some sources, the success rate with this method is an high as 80%.

Endorectal advancement flap:
Endorectal advancement flap is the procedure in which the internal opening of fistula is identified and flat of mucosal tissue is cut around the opening.