A Comparison of Laser and Fistulotomy Techniques in the Treatment of Fistula-in-Ano

Abstract

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.

Focus on the Internal Orifice Closure and Mucosal Advancement Flap in FILAC Technique

“…Patients may emerge with recurring perianal abscess and fistula if the abscess is not thoroughly drained. In between 40% and 66% of perianal abscesses, an anal fistula develops (1).…”

Role of Fibrin Glue versus Fistulotomy in Treatment of High Fistula-In-Ano

“…It involves a partial incision of the internal and external sphincter muscles, which is limited to less than one third of their extent. This method is known to be safe in terms of preserving continence in patients and does not lead to incontinence [9,10] .…”