Anal fistulas are common in anorectology, and about 5% of all fistula patients have tuberculous fistulas, which are particularly common in young adult men. Because there is no unified treatment standard for these fistulas, patients often receive different treatment plans from different doctors, and the fear of surgery often makes patients feel overwhelmed. They often ask the same question: Do I have to have surgery to cure my anal fistula? To answer this question, we first need to understand what a tuberculous fistula is. The most common cause is eating food or swallowing sputum with Mycobacterium tuberculosis, which is carried to the skin near the anus through the digestive tract and eventually forms a focal point of infection. Of course, there are also a few cases in which the bacteria reach the anus through the bloodstream and cause an infection. The symptoms of nodular fistula are different from those of common fistula: the local redness and swelling are usually not very pronounced, the pain is relatively less intense, the abscess takes longer to break down, and the granulation tissue of the ulcer appears pale and the surrounding skin is mostly dull black; the external opening of this fistula is large and irregular, far from the anal opening, and the edge of the external opening is often sunken and curled, The fistula has more branches, the pus is thin and yellowish, often accompanied by rice slop-like and cheese-like secretions; the anorectal surgeon will find that the fistula has a wide canal, a large span of irregularity, a large internal opening, and uneven margins, which do not conform to the direction and distribution of a normal anal fistula. It is important to note that although tuberculous anal fistula is mostly a part of systemic tuberculosis infection, we often find that most patients with tuberculous anal fistula do not have obvious symptoms of systemic tuberculosis infection, but are often detected and diagnosed through clinical observation of local conditions combined with pathological biopsy and routine preoperative examination. How should tuberculous fistula be treated? Does surgery have to be performed to cure it? There are three main clinical options for the treatment of tuberculosis: surgical treatment, local treatment and anti-tuberculosis treatment. For some patients, especially if surgery is not curable or if there are other reasons why the patient cannot tolerate surgery, early, combined, appropriate, full and regular systemic anti-tuberculosis treatment can bring the anal fistula to a relatively ideal stable state, that is In this state, the fistula may not recur for years or decades, and there is little impact on life. However, for most patients, surgery is necessary or the best option. A study comparing surgery or anti-tuberculosis treatment followed by surgery found that patients recovered better and had a lower recurrence rate after surgery, thus confirming that anti-tuberculosis treatment is relatively better and safer when conditions permit. Of course, for patients with significant local symptoms that require early local surgical management, this is a different story. As for the choice of surgery, it is a matter for the anorectal specialist and must be determined according to the actual situation of the patient, including incision and drainage, hanging, tube flushing and local drug treatment. In short, in a word, tuberculous fistula is operable, but not all patients have to be operated. If surgery is needed, the timing of surgery and the choice of surgical approach will be directly related to the outcome of the treatment. Therefore, in this case, it is especially necessary to visit the anorectal department of a regular hospital.