Treatment of the fistula tract with laser ablation in high anal fistula

Erkan Karacan 1, Eyüp Murat Yılmaz 2 *
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1 General Surgery Department, Karabük University Research and Training Hospital, Karabük, Turkey
2 General Surgery Department, Aydın General Surgery Clinic, Aydin, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 6, pp. 43-45. https://doi.org/10.23950/jcmk/12685
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ABSTRACT

Aim and introduction: Considering the recurrence and fecal incontinence rates in high anal fistulas, surgical treatment of anal fistulas is a challenging process, although many treatments have been defined today. The aim of our study is to evaluate the long-term results of laser ablation of the fistula tract in high anal fistulas.
Material and methods: The files of patients who underwent laser ablation of the fistula tract due to high anal fistula between June 2020 and January 2022 were evaluated retrospectively. Moreover, their postoperative complications, preoperative and postoperative Cleveland fecal incontinence scores (CCFFSI score), postoperative first day and first-week visual analog scale (VAS) scores, follow-up times, and recurrence rates were analyzed.
Results: 26 patients were included in the study. The mean follow-up period was 39.88±14.34 weeks, and the postoperative first and 7th day VAS scores were 4.61±1.41 and 0.8±1.02, respectively. Preoperative and postoperative CCFI scores were calculated as 1.8±1.41, 1.65±1.32, respectively. Recurrence was observed in 7 patients postoperatively. Postoperative anal abscess developed in 1 patient.
Conclusion: Although laser ablation of the fistula tract can be safely performed as a technique that does not affect incontinence, recurrence rates should also be considered. Furthermore, more extensive randomized prospective studies on this technique should be performed.

CITATION

Karacan E, Yılmaz EM. Treatment of the fistula tract with laser ablation in high anal fistula. J CLIN MED KAZ. 2022;19(6):43-5. https://doi.org/10.23950/jcmk/12685

REFERENCES

  • Emile SH, Elfeki H, Thabet W, Sakr A, Magdy A, El-Hamed TMA, et al. Predictive factors for recurrence of high transsphincteric anal fistula after placement of seton. J Surg Res. 2017;213:261-268. https://doi.org/10.1016/j.jss.2017.02.053
  • Adegbola SO, Sahnan K, Pellino G, Tozer PJ, Hart A, Phillips RKS, et al. Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistula: a systematic review. Tech Coloproctol. 2017;21(10):775–782. https://doi.org/10.1007/s10151-017-1699-4
  • Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, García-Granero E. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis. 2017;32(5):599–609. https://doi.org/10.1007/s00384-017-2779-7
  • Hong KD, Kang S, Kalaskar S, Wexner SD. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol. 2014;18:685–691 https://doi.org/10.1007/s10151-014-1183-3
  • Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol. 2011;15(4):417–422. https://doi.org/10.1007/s10151-011-0769-2
  • Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol. 2011;15(4):445–449. https://doi.org/10.1007/s10151-011-0726-0
  • Shirah BH, Shirah HA. The impact of the outcome of treating a high anal fistula by using a cutting seton and staged fistulotomy on saudi arabian patients. Annals of Coloproctology. 2018;34(5):234-240. https://doi.org/10.3393/ac.2018.03.23
  • Yeung JM, Simpson JA, Tang SW, Armitage NC, Maxwell-Armstrong C. Fibrin glue for the treatment of fistulae in ano–a method worth sticking to? Colorectal Dis. 2010;12:363–366. https://doi.org/10.1111/j.1463-1318.2009.01801.x
  • Cestaro G, De Rosa M, Gentile M. Treatment of fistula in ano with fibrin glue: preliminary results from a prospective study. Miner Chir. 2014;69:225–228
  • Emile SH, Khan SM, Adejumo A, Koroye O. Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: an updated systematic review, meta-analysis, and meta-regression of the predictors of failure. Surgery. 2020;167(2):484–492. https://doi.org/10.1016/j.surg.2019.09.012
  • Celayir MF, Bozkurt E, Aygun N, Mihmanli M. Complex anal fistula: long-term results of modified ligation of intersphincteric fistula tract=LIFT. The Medical Bulletin of Sisli Etfal Hospital. 2020;54(3): 297-301 https://doi.org/10.14744/SEMB.2020.89106
  • Kılıç A, Tilev SM, Başak F, Şişik A. Rectal flap experience in high transsphincteric cryptoglandular anal fistula. J Surg Med. 2019;3(10):746-748. https://doi.org/10.28982/josam.636918
  • Bakhtawar N, Usman M. Factors increasing the risk of recurrence in fistula-in-ano. Cureus. 2019;11:4200. https://doi.org/10.7759/cureus.420010.1016/j.surg.2019.09.012
  • Stijns J, Van Loon YT, Clermonts SHEM, Göttgens KW, Wasowicz DK, Zimmerman DDE. Implementation of laser ablation of fistula tract (LAFT) for perianal fistulas: do the results warrant continued application of this technique? Tech Coloproctol. 2019;23:1127–1132. https://doi.org/10.1007/s10151-019-02112-9
  • Öztürk E, Gülcü B. Laser ablation of fistula tract: a sphincter-preserving method for treating fistula-in-ano. Dis Colon Rectum. 2014;57:360–364. https://doi.org/10.1097/DCR.0000000000000067
  • Ege B, Leventoğlu S, Mentes BB¸ Yılmaz U, Oner AY. Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients, Tech Coloproctol. 2014;18:187–193. https://doi.org/10.1007/s10151-013-1021-z
  • Giamundo P, Geraci M, Tibaldi L, Valente M. Closure of fistula-in-ano with laser--FiLaC™: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis. 2014;16:110–115. https://doi.org/10.1111/codi.12440
  • Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaCTM laser for fistula-in-ano management:long-term follow-up from a single institution. Tech Coloproctol. 2017;21:269–276. https://doi.org/10.1007/s10151-017-1599-7