Fistula-tract laser closure versus fistulotomy with primary sphincteroplasty for treatment of transsphincteric anal fistula: a prospective controlled study

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Abstract

Background
Fistula surgery is challenging owing to high incidence of postoperative complications such as recurrence and incontinence. The best surgical option provides complete healing of the fistula and saving sphincter function.
Aim
To assess and compare fistula-tract laser closure (FiLaC) and fistulotomy with primary sphincteroplasty (FIPS) for management of transsphincteric anal fistula regarding their efficacy and postoperative complications.
Patients and methods
A total of 100 patients with transsphincteric anal fistula were divided into two groups: group A (=50, FiLaC) and group B (=50, FIPS). They were subjected to clinical assessment and MRI of the perianal region. Patients were followed up for 12 months to assess postoperative complications, recurrence, and continence.
Results
The patients’ ages ranged from 18 to 65 years. Overall, 78% in group A were males versus 74% in B (>0.05). Mean operative time and postoperative hospital stay were shorter in group A (24.7 ± 4.33 vs. 35.1 ± 7.65 min, and 1 ± 0 vs. 2.9 ± 1.2 days, respectively; <0.01). Recurrence rates were higher in group A (26 vs. 8%, <0.05) but with better continence scores. A strong negative correlation was found between good fitting of fistula tracts on the 1.5-mm metal probe and recurrence (=−0.628, <0.01) and a weak correlation between MRI fistula length and percentage of sphincter affection with recurrence (=−0.101 and =0.147, >0.05).
Conclusion
FiLaC had great outcomes in treating transsphincteric anal fistula in patients with long fistula tracts and appropriate caliber in relation to laser probe, whereas FIPS remained a good option with low recurrence and minimal affection of the continence.

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