Fistula laser closure versus lay open and primary sphincter repair versus staged rerouting operation in management of transsphincteric perianal fistula: A prospective randomized controlled trial

Document Type : Original Article

Authors

1 Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

2 Department of Colorectal and Anal Surgeries, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Abstract

Background: Peri-anal fistula is one of the prevalent anal diseases. Controlling the infection and preserving faecal
continence are the primary objectives of therapy. Surgeons frequently employ fistulotomy, primary sphincter repair,
phased rerouting procedures, and fistula tract laser closure (FiLaC), a recent sphincter-preserving technique also used to
treat peri-anal fistulas.
Aim: To assess outcome and efficacy of FiLaC versus lay open and primary sphincter repair versus staged rerouting
operation in management of trans-sphincteric perianal fistula.
Patients and Methods: This was a prospective randomized controlled trial that was conducted at Ain Shams University
Hospitals. It included 45 patients diagnosed with transsphincteric perianal fistula. The study period was 18 months,
including 6 months duration for follow-up. Study began in August 2022.
Results: Our results showed that FiLaCgroup has higher recurrence rate compared with other two groups at 3 and 6 months follow-up. Although in terms of postoperative pain (visual analog scale (VAS) score) There was a highly statistically significant difference between the three study groups (P=0.001). As FiLaC group showed a low postoperative VAS score when compared with the other two groups. Together with operative time and postoperative hospital stay, results showed that FiLaC group was superior in comparison to the other two groups (P=0.001). Otherwise concerning the postoperative bleeding, wound infection, Healing, and WEXNER score, there was no statistically significant difference
detected between the three study groups were (P>0.05).
Conclusion: Lay open with phased rerouting and primary sphincter repair had a reduced recurrence rate and a greater
success rate. However, in terms of operating time, hospital stay following surgery, VAS score, and WEXNER score,
FiLaC was better. All studied approaches were safe and effective in treating trans-sphincteric perianal fistula.

Keywords

The Egyptian Journal of Surgery
Volume 44, Issue 2
April 2025
Pages 727-734

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