Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis

Mei, Zubing; Zhang, Zhijun; Han, Ye; Du, Peixin; Yang, Wei; Wang, Qing-Ming; Zheng, De

doi:10.1371/journal.pone.0279388

Cited by 6 publications

(2 citation statements)

References 34 publications

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“…14–17 Ablative lasers also improved vascularity, pliability, pigmentation, and scar height outcomes in the meta-analysis performed by Ma et al in 2023. 18…”

Section: Discussionmentioning

confidence: 99%

Picosecond Nd:YAG versus Fractional CO2 Lasers in Management of Postburn Scars

Tawfik,

Hanafy,

Ali

2024

Plastic and Reconstructive Surgery - Global Open

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Background: The picosecond laser was primarily designed to enhance tattoo removal. Because it has a new innovative mechanism for energy delivery, it has been modified to be used in other conditions such as skin resurfacing, which was usually treated with fractional CO2 laser. Comparing both technologies in managing postburn scars has not been widely addressed. Methods: The current prospective comparative randomized intrapatient study was done on 15 patients who presented with unsightly postburn scarring. As a split study, one-half of the affected areas were treated using the picosecond Nd: YAG laser. The other areas were treated with a fractional CO2 laser. After three treatment sessions, the results were analyzed both objectively and subjectively. Results: The assessment by the image analysis system (Antera camera) showed improvement in all the parameters in both groups. The melanin relative variation decreased from 11.65 ± 2.86, 15.85 ± 5.63 to 10.60 ± 1.96, 12.56 ± 3.98, respectively in picosecond laser sites and fractional CO2 sites. The percentage change in overall opinion decreased in in favor of the fractional CO2 laser sites, which is a statistically significant improvement. Instead, color scores revealed a greater reduction in the picosecond sites in comparison with the fractional CO2 sites, as it decreased from 7.67 ± 1.76, 7.73 ± 1.83 to 2.87 ± 1.06, 6 ± 1.2, respectively. Conclusions: When compared with fractional CO2 lasers, picosecond Nd:YAG shows comparable improvements in scars’ erythema, texture, and height, with some superiority in the management of hyperpigmented scars.

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“…14–17 Ablative lasers also improved vascularity, pliability, pigmentation, and scar height outcomes in the meta-analysis performed by Ma et al in 2023. 18…”

Section: Discussionmentioning

confidence: 99%

Picosecond Nd:YAG versus Fractional CO2 Lasers in Management of Postburn Scars

Tawfik,

Hanafy,

Ali

2024

Plastic and Reconstructive Surgery - Global Open

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“…The risk of incontinence is seen as the most crucial barrier in MAF (mucosal advancement flap), even though it is by definition a sphincter-sparing procedure. A increased risk of incontinence is frequently linked to the use of the core out approach, partial and full thickness flaps, and important anal dilatation during surgery (8). It is important that during surgery, the risk factors for recurrence are identified and managed.…”

Section: Discussion Discussionmentioning

confidence: 99%

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

Cimpean,

Baillon,

Mehdi

2024

SGO

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A cryptoglandular abscess, which can result in a perianal abscess and fistula, is caused by an anal gland infection. An anal fistula occurs in 40-66% of perianal abscesses. The general indications for this method range from high trans sphincteric fistulas to "short" (3 cm) trans sphincteric fistulas to inter sphincteric fistulas. We present the case of a 36-year-old patient who has a trans sphincteric anal fistula. The patient had an anal abscess that was drained in emergency. A seton was placed when an internal opening in the anal canal was detected. Local irrigations with a good evolution were used for local care. In the absence of infection and inflammation, we decided to proceed with the FILAC surgery with internal orifice closure and mucosal advancement flap, the second phase in the anal fistula treatment. Simple sutures may be less successful if the internal opening is surrounded by fibrous, poorly vascularized scar tissue. We believe that proper sealing of the fistula trajectory from faecal spillage is critical for complete healing after Laser treatment and can reduce the morbidity and recurrence. One of the most important aspects in fistula therapy is the correct closure of the internal opening of the fistula trajectory with adequate measures to avoid incontinence.

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Evaluating the efficacy of multi-incision and tube-dragging therapy combined with laser closure for high horseshoe-shaped anal fistula: Protocol of a prospective, randomized, controlled trial

Yang,

Mei,

Wang

et al. 2024

PLoS ONE

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Introduction High horseshoe-shaped anal fistula (HHAF) is a complicated and challenging condition that presents considerable obstacles in treatment. We are presently investigating a novel surgical technique involving a combination of multi-incision and tube-dragging therapy, and laser closure (MITD-LaC) for the management of HHAF. Due to the current scarcity of rigorous evidence evaluating this approach, it is essential to perform a well-designed randomized controlled trial to compare the effectiveness of this new method with incision and thread-drawing therapy. Methods and analysis This trial is a prospective, randomized, controlled and interventional study. After preliminary screening of qualified outpatients, a total of 64 adult patients will be enrolled in the trial and randomly allocated to either the MITD-LaC group or the control group (n = 32 per group). These patients will receive either MITD-LaC or incision and thread-drawing therapy. The design aims to allow for a robust comparison between the two treatment modalities. The primary endpoint is the wound healing time, while secondary endpoints include postoperative anal pain at 1, 3, and 5 days (measured with visual analogue scale), fecal incontinence score within 30 days after operation (measured with Cleveland Clinic Florida incontinence score), and the occurrence of postoperative complications within 1 month after surgery, and quality of life up to six months postoperatively (evaluated by The Quality of Life in patients with Anal Fistula Questionnaire Score). Discussion This study represents the first randomized controlled trial evaluating the short-term outcomes of MITD-LaC, thereby aiming to contribute high-quality evidence to guide clinical practice. Moreover, this trial incorporates comprehensive outcome measures assessing both subjective and objective dimensions. Because of this multidimensional assessment, MITD-LaC offers a promising potential for broader application in the treatment of HHAF. Consequently, obtaining more definitive and authoritative evidence through scientifically rigorous clinical trials is of utmost importance in further validating this treatment approach. Ethics and dissemination We have submitted the clinical study protocol to the Ethics Committee, and it has been approved under ethical approval number 2021-1036-111-01. The results of the trial will be disseminated through peer-reviewed academic journals and presentations at professional conferences. Registration number ChiCTR2100053556.

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Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis

Cited by 6 publications

References 34 publications

Picosecond Nd:YAG versus Fractional CO2 Lasers in Management of Postburn Scars

Picosecond Nd:YAG versus Fractional CO2 Lasers in Management of Postburn Scars

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

Evaluating the efficacy of multi-incision and tube-dragging therapy combined with laser closure for high horseshoe-shaped anal fistula: Protocol of a prospective, randomized, controlled trial

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