Anal fistula closure with FiLaC: new hope or the same old story?

Abstract

Throughout the centuries human beings have suffered from anal fistula.The history of medicine is full of reports about the treatment of this pathology and, in recent times, when attention has focused on preserving continence and quality of life has become a central issue in medical practice, many new sphincter-saving techniques have been proposed.Few diseases have such a wide range of severity and anatomical variations. The disease spectrum ranges from simple submucosal fistula tracts to an extrasphincteric fistulas involving multiple tracts and, while the treatment of the simplest ones is easy and safe, the more complex fistulas require expert surgeons and often multiple operations.The modern surgical approach to anal fistulas includes several sphincter-saving procedures including the closure of the fistula tract with plugs, fibrin glue, or collagen paste without fistulotomy (i.e., laying open) or by means of fistulectomy (i.e., core-out technique) [1]. However, despite several encouraging reports, though few randomized controlled trials, there is still some skepticism among coloproctologists about the effectiveness of these new sphincter-saving procedures.

Clinical Effect of Tunnel-Like Fistulectomy Plus Draining Seton Combined with Incision of Internal Opening of Anal Fistula (TFSIA) in the Treatment of High Trans-Sphincteric Anal Fistula

“…Over the last decade, many minimally invasive techniques have been developed, including fistula laser closure (FiLaC) [8,9], video-assisted anal fistula treatment (VAAFT) [10], and ligation of intersphincteric fistula track (LIFT) [11][12]. These methods are mainly concerned with the closure of the internal opening, which are relatively effective (healing rate is 81.8% [9], 70% [10], and 84% respectively) [12].…”

Sphincter‐sparing surgery for complex anal fistulas: radiofrequency thermocoagulation of the tract is of no help

“…Rectal advancement flap methods are the classic strategies. Other approaches attempt to achieve coagulation or closure of the fistulous tract through heat destruction, occlusion or ligation . However, these new methods are mainly case series without any comparative evaluation .…”

Efficacy of Low-Level Laser Therapy on Fistula-in-Ano Treatment

“…Many publications 1,3,4,7,11,16,19,20 have appeared in recent years on the use of low-level laser in the treatment of anal fistula, but all in humans and with a specific product that requires a probe for internal laser application. Despite the good results presented, as also seen in other techniques 9,15 , it is necessary to consider the high cost, the need of hospitalization and the need to close the internal orifice according to the description of the technique.…”