Anal fistula surgery primarily involves fistulotomy and ligation, with the surgery’s difficulty and potential for pain depending largely on the severity of the condition and the type of anesthesia used. If local anesthesia is used, patients may experience localized pain six hours post-surgery, especially in cases where the fistula is deep or complex, as the larger surgical wounds tend to cause more intense pain. If a spinal anesthesia method is used, incorporating methylene blue injection for nerve block during surgery, postoperative pain may be slightly less intense. Generally, localized pain might occur after 12 hours. If the pain is severe, patients can be treated with oral or topical pain-relieving medication.