Background Anal fistulas present a complex challenge necessitating precise identification of concealed internal openings for successful intervention. Locating internal openings during preoperative diagnostic imaging can be challenging and failure to do so may lead to unresolved sepsis and the need for recurrent procedures. Methods A cohort of 53 patients undergoing surgical intervention for anal fistulas was divided into subgroups based on the operative technique used. Palpation and guided probing diluted and undiluted H2O2 application, limited fistulotomy and probing, and limited fistulotomy with H2O2 instillation were implemented. Demographic, clinical, and operative data were collected retrospectively. Success rates, defined as accurate identification of concealed internal openings, were assessed for each technique. Results findings revealed variations in the success rates of the operative techniques. Palpation and guided probing achieved a success rate of 75.47%, diluted H2O2 68.93%, undiluted H2O2 72.34%, limited fistulotomy and probing 61.54%, and limited fistulotomy with H2O2 instillation exhibited the highest success rate with an impressive 83.46%. Comparative analysis using chi-square tests indicated significant differences in success rates among the techniques. Conclusion Limited fistulotomy with H2O2 instillation demonstrated the highest success rate (83.46%), underscoring its potential as an effective approach. Surgeons may consider these results when selecting operative techniques based on individual patient characteristics.