Our Summary
This research paper is a study of the use of a specific laser procedure, Fistula laser closure (FiLaC®), to treat anal fistulas - abnormal connections between the anal canal and the skin near the anus - over a period of ten years. The study included 175 patients who had this treatment between June 2009 and May 2019. The main goal of the study was to determine how many patients healed after the treatment, with additional objectives to assess any complications and identify any factors that might predict failure of the treatment.
Fistulas were of three types: transphincteric (occurring through the sphincter muscles), intersphincteric (occurring between the inner and outer sphincter muscles), and suprasphincteric (occurring above the sphincter muscles). Most of the patients were treated with a seton or draining silicon loop before the laser procedure.
After an average follow-up period of 60 months, it was found that around 67% of the patients had healed. About 22% of patients did not heal, and 11.4% had recurrence. Those patients who had a seton or loop inserted before the laser procedure had a significantly higher success rate.
Some patients needed to be operated on again after the laser treatment. Of these, about half were re-treated with the same laser procedure, and about half of these patients healed, resulting in a secondary success rate of 73.7%.
In conclusion, the ten-year study confirms that the FiLaC® laser procedure is effective in treating complex anal fistulas and its use should be encouraged.
FAQs
- What is the Fistula laser closure (FiLaC®) procedure and what is it used to treat?
- What was the success rate of the FiLaC® laser procedure in the ten-year study?
- Were there any factors that predicted the success or failure of the FiLaC® laser procedure?
Doctor’s Tip
A doctor might tell a patient undergoing anal fistula surgery that the FiLaC® laser procedure has shown to be effective in treating complex anal fistulas, with a success rate of around 67% after an average follow-up period of 60 months. Patients who had a seton or draining silicon loop inserted before the laser procedure had a higher success rate. In cases where the fistula recurs, the same laser procedure can be used again with a secondary success rate of 73.7%. It is important to follow post-operative care instructions and attend follow-up appointments to ensure optimal healing and recovery.
Suitable For
Patients who are typically recommended anal fistula surgery are those with complex anal fistulas that have not responded to conservative treatments such as antibiotics or drainage procedures. These patients may experience symptoms such as persistent discharge, pain, swelling, or recurrent infections. Additionally, patients with recurrent anal fistulas or those with certain types of fistulas such as transphincteric or suprasphincteric fistulas may be candidates for surgical intervention.
In the study mentioned above, the FiLaC® laser procedure was found to be effective in treating complex anal fistulas, particularly in patients who had a seton or draining loop inserted before the laser treatment. This suggests that patients with more severe or complex fistulas may benefit from this type of surgical approach.
Overall, patients who are recommended anal fistula surgery are those who have not responded to conservative treatments and who have complex or recurrent fistulas that require more advanced intervention. It is important for these patients to discuss their treatment options with a healthcare provider to determine the best course of action for their individual situation.
Timeline
Before the anal fistula surgery, patients may experience symptoms such as pain, swelling, discharge, and difficulty passing stool. They may undergo tests such as a physical examination, ultrasound, MRI, or fistulography to determine the extent and type of fistula.
After the surgery, patients may experience some discomfort, swelling, and drainage from the surgical site. They will need to follow post-operative care instructions, such as keeping the area clean, taking pain medication as prescribed, and avoiding strenuous activities. Follow-up appointments will be scheduled to monitor healing and check for any complications.
Over time, the majority of patients should experience healing of the fistula and improvement in symptoms. However, some patients may require additional treatments or surgeries if the fistula does not heal or recurs. It is important for patients to continue to follow up with their healthcare provider to ensure proper healing and management of the anal fistula.
What to Ask Your Doctor
Some questions a patient should ask their doctor about anal fistula surgery include:
- What type of anal fistula do I have, and how will it be treated with the FiLaC® laser procedure?
- What are the potential risks and complications associated with the surgery?
- What is the success rate of the FiLaC® procedure for treating anal fistulas?
- Will I need any additional treatments or surgeries after the FiLaC® procedure?
- How long is the recovery period, and what can I expect in terms of pain and discomfort?
- Are there any lifestyle changes or precautions I should take after the surgery to prevent recurrence?
- What factors might affect the success of the treatment in my case?
- How often will I need follow-up appointments to monitor my healing progress?
- Are there any alternative treatments or procedures available for my anal fistula?
- Can you provide me with any additional resources or information about anal fistula surgery and the FiLaC® procedure?
Reference
Authors: Giamundo P, De Angelis M. Journal: Tech Coloproctol. 2021 Aug;25(8):941-948. doi: 10.1007/s10151-021-02461-4. Epub 2021 May 19. PMID: 34013497