Sphincter-saving therapy for fistula-in-ano: long-term follow-up after FiLaC

• Published in: Techniques in coloproctology 2021-02, Vol.25 (2), p.177-184
• Main Authors: Wolicki, A., Jäger, P., Deska, T., Senkal, M.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Anal Canal - surgery; Colorectal Surgery; Fistula; Follow-Up Studies; Gastroenterology; Humans; Ligation; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patients; Proctology; Rectal Fistula - surgery; Retrospective Studies; Surgery; Surgical techniques; Treatment Outcome
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-020-02332-4

Background The treatment of anal fistula remains a challenge between maintaining continence and radical surgery to prevent recurrence. Fistula-tract Laser Closure (FiLaC ® ) is a sphincter-saving technique using a radial emitting laser fibre to close the fistula tract. The aim of this study was to report long-term outcomes in patients who received FiLaC ® therapy for transsphincteric and intersphincteric anal fistula between January 2011 and December 2017. Methods A retrospective study was performed on patients who were treated with FiLaC ® - for a transsphincteric and intersphincteric anal fistula at our institution between January 2011 and December 2017. In all patients, the FiLaC ® procedure was combined with a closure of the internal orifice using a simple 3-0 Z stitch. Patient characteristics, previous proctological history, healing rates, failures and postoperative continence were investigated. Results The study included 83 patients [mean age 50.01 ± 14.59 years. 64 (77.1%) males] with a mean follow-up period of 41.99 (± 21.59) months (range 4–87 months). Thirteen patients (15.7%) had a recurrent fistula. 65 patients (78.3%) had undergone prior abscess drainage with insertion of a seton. The primary healing rate was 74.7% (62 of 83 patients) overall. Eleven (13.3%) of the 21 patients (25.3%) who failed FiLaC ® -therapy underwent a second operation. In eight cases, Re-FiLaC ® and in three cases, fistulectomy with closure of the internal orifice was performed. Afterwards 6 (54.5%) of these 11 patients could be considered cured: 3 who had fistulectomy and three who had Re-FiLaC ® treatment. The overall healing rate after second FiLaC ® was 78.3% (65 of 83 patients) while the overall healing rate for FiLaC ® therapy combined with any second procedure was 81.9% (68 of 83 patients). The follow-up period in this group of 11 patients who received re-operation was 38 months (range 13–84 months). Changes in continence occurred in eight patients (9.6%). No patient reported major incontinence postoperatively. Conclusions The FiLaC ® procedure is associated with good healing rates in long-term follow-up and should be considered as a treatment option for transsphincteric and intersphincteric anal fistulae, especially due to the low complication rate and low risk of sphincter injury.