BackgroundAnal fistulas are a common complication of perianal abscesses. The treatment of anal fistulas is challenging, with persistent and high recurrence rates. The aim of this study was to evaluate the efficacy and costeffectiveness of laser ablation compared to fistulotomy in the treatment of anal fistulas. Materials and methodsThe patients were examined for external and internal openings of the fistula, its number, length, type, relationship with the sphincters, and any previous history of abscess or proctological surgery. The surgical procedures, complications, incontinence, recurrence, and recovery time were evaluated and compared between the two groups. The laser ablation group received an intermittent laser application at a wavelength of 1470 nm and 10 watts for three seconds, while the fistulotomy group underwent cutting of the fistula tract with electrocautery while keeping a stylet in place. ResultsA total of 253 patients were included in this retrospective study, with 149 patients undergoing fistulotomy and 104 patients undergoing laser ablation. The patients were evaluated based on the type, number, and location of internal and external openings, and the length of the fistula tract according to the Parks classification. The mean follow-up period was 9.0±4.3 months. The results showed that the laser group had a shorter time to return to work and less postoperative pain compared to the fistulotomy group. However, the recurrence rate was higher in the laser group. The recurrence rate was also found to be higher in patients with low transsphincteric fistulas and in patients with diabetes mellitus. ConclusionOur study findings indicate that while laser ablation may be associated with less pain and quicker recovery time, it may also have a higher recurrence rate compared to fistulotomy. We believe that laser ablation is a valuable option for surgeons to consider early on in the treatment process, especially in cases where fistulotomy is not suitable.
BackgroundHemorrhoidal disease is a common ailment that presents a challenge in terms of standard treatment methods. Although surgical hemorrhoidectomy is often considered the gold standard, new surgical techniques have emerged, such as laser hemorrhoidoplasty and LigaSure hemorrhoidectomy, to address postoperative pain, bleeding, and extended return‐to‐work times. This study aims to compare the outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in patients with grade II–III hemorrhoidal disease.MethodsA retrospective analysis was conducted on a cohort of patients who underwent laser hemorrhoidoplasty or LigaSure hemorrhoidectomy. Data were collected on postoperative pain, complications, recurrence rates, and return‐to‐work times. The primary outcome was the difference in postoperative pain between the two groups, as assessed using the Visual Analog Scale (VAS).ResultsPatients in the laser hemorrhoidoplasty group experienced significantly lower postoperative pain compared to those in the LigaSure hemorrhoidectomy group. Bleeding amounts during the operation were also significantly lower in the laser group. However, the recurrence rate was higher in the laser group compared to the LigaSure group (9.4% versus 2.5%). Return to work and normal activities time after laser hemorrhoidoplasty was shorter than after LigaSure hemorrhoidectomy.ConclusionLaser hemorrhoidoplasty is a minimally invasive technique that can be safely applied in suitable grade II–III patients, offering lower postoperative pain rates, fewer complications, and shorter return to work and normal activity times compared to LigaSure hemorrhoidectomy. However, recurrence rates are still higher for laser hemorrhoidoplasty. Future studies should explore the potential of combining laser hemorrhoidoplasty with other surgical treatments.
Purpose: The aim of the current study was to compare the preoperative examination findings, endoanal ultrasonography results, and operative findings in patients diagnosed with perianal fistula. Materials and Methods: A prospective study was conducted between 2021 and 2022 on patients who underwent surgical treatment for perianal fistula. The patients were recorded and classified according to the Park classification by the surgeon performing the operation. Subsequently, a surgeon with 10 years of endoanal ultrasonography experience reclassified the patients and recorded the findings (Ultrasonographic Evaluation - USE). The surgery was performed by a different surgeon who was blind to the USE results and the final diagnosis was recorded (Evaluation Under Anesthesia - EAU). The preoperative examination findings, endoanal ultrasonography findings, and operative findings were compared postoperatively. Results: The study included 60 patients, with 52 being male and 8 being female, and a mean age of 44.2 ± 12.6 years. The patients were classified as low transsphincteric (TSF), intersphincteric (ISF), and high TSF at ratios of 40%, 33.3%, and 26.7%, respectively (24, 20, and 16 patients, respectively). Endoanal ultrasonography found that 30%, 35%, and 21.7% of patients had low TSF, ISF, and high TSF, respectively (18, 21, and 13 patients, respectively), while postoperatively, 45%, 33%, and 21.7% of patients were classified as low TSF, ISF, and high TSF, respectively (27, 20, and 13 patients, respectively). The ISF rate in preoperative examination findings was significantly higher than in postoperative diagnoses, with intermediate coherence between the two diagnoses (κ: 0.462). The rates of low and high TSF were found to be significantly higher in ultrasonography findings than in postoperative diagnoses, with high coherence between the two (κ: 0.701). Conclusion: Endoanal ultrasonography is important for mapping, especially for transsphincteric fistulas, in the surgical treatment of perianal fistulas.
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