A single institution experience in the treatment of fistula in ano using diode laser (fistula laser closure): short-term outcomes

Elsheikh, Mostafa M.; Elghamry, Elghamry E.; Elsayed, Alhassan M. H.; Abdel-Hady, Hamdy; Talaat, Mohamed; Amer, Ahmed H.

doi:10.4103/ejs.ejs_178_23

A single institution experience in the treatment of fistula in ano using diode laser (fistula laser closure): short-term outcomes

Authors

Abstract

Introduction
Management of the perianal fistula has been always a challenge for colorectal surgeons especially when the external sphincter is involved. Several minimally invasive procedures emerged as an alternative to the traditional surgical approach as fibrin glue injection, ligation of the intershpincteric track (LIFT) and injection of platelet-rich plasma (PRP). Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and sealing of the fistulous track that depends on the power and the duration of laser light application.
Patients and methods
This study was carried out on 69 patients with perianal fistula in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period from February 2021 to December 2022. Patients underwent fistula laser closure (FILAC) using a diode laser, radial fibers, wavelength 1470 nm, and 10 watts of power.
Results
Sixty nine patients underwent fistula laser closure. The success rate was 74%. There was significance between recurrence and posterior position of the fistulous track of the intersphincteric type. Also, there was significance between recurrence and cases who had a caliber track more than 7 mm but there was no significance between recurrence and length of the track. The procedure was associated with minimal postoperative pain, long period of postoperative discharge, short hospital stay, and early return to normal activities.
Conclusion
Diode laser is a safe minimally invasive and effective procedure for the treatment of straight non branched short track fistula with some considerations as the caliber track should not exceed 7 mm and the posterior intersphincteric fistula should be treated by lay open fistulotomy. The procedure is also associated with less postoperative pain, early return to normal activities, and minimal recurrence rate but high cost remains a limitation.

Keywords