Closing perianal fistulas using a laser: Long-term results in 103 patients


Terzi M. C., AĞALAR C., Habip S., Canda A. E., Arslan N. Ç., Obuz F.

Diseases of the Colon and Rectum, vol.61, no.5, pp.599-603, 2018 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Abstract
  • Volume: 61 Issue: 5
  • Publication Date: 2018
  • Doi Number: 10.1097/dcr.0000000000001038
  • Journal Name: Diseases of the Colon and Rectum
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.599-603
  • Keywords: Fistula-tract Laser Closure, Laser closure, Perianal fistula
  • Istanbul Medipol University Affiliated: No

Abstract

BACKGROUND: Primary closure of the fistula tract using energy emitted by a radial fiber connected to a diode laser is a novel procedure for treating perianal fistulas. OBJECTIVE: The aim of this study was to determine the long-term effectiveness of this new technique. DESIGN: The surgical objective was to seal the fistula tract using laser energy. SETTINGS: The study was conducted at a single day-case surgery center. PATIENTS: Between April 2012 and June 2016, 103 consecutive patients with primary or recurrent perianal fistula underwent a laser closure procedure using a 12-watt laser emitting at a wavelength of 1470 nm. MAIN OUTCOME MEASURES: Patients were classified according to the Park classification, and healing was evaluated based on the perianal fistula disease severity score. RESULTS: Among the 103 patients treated using the laser closure procedure, 82 (80%) were men and 21 (20%) were women. The median age of the patients was 43 years (range, 18-78 y). Fifty-three patients (52%) had previous perianal fistula repair surgery. Based on the Park classification, 56 patients (54%) had intersphincteric fistula, 29 (28%) had transsphincteric fistula, 11 (11%) had suprasphincteric or extrasphincteric fistula, and 7 (7%) had superficial perianal fistula. Based on the perianal disease severity score, 41 patients (40%) obtained overall complete healing, 38 (37%) had persistent symptomatic drainage, 20 (19%) had slight drainage with minimal symptoms, and 4 (4%) had painful symptomatic drainage. LIMITATIONS: This was a retrospective analysis of noncomparative data with a lack of formal prospective continence assessment. CONCLUSIONS: Closure of perianal fistulas using a laser should be considered as a treatment option but with modest expectations. Although our complete healing rate was not as high as in earlier studies, this technique is a reasonable option with nearly no risk of sphincter damage when treating perianal fistulas. See Video Abstract at http://links.lww.com/DCR/A545.