Comparison of Laser Ablation and Fistulectomy with Sphincteroplasty for the Management of Transsphincteric Fistulas Following Preliminary Seton Insertion

Abstract

Background: Cryptoglandular perianal fistulas are a frequent problem, and the traditional surgical procedure carries a risk of incontinence and recurrence. The ultimate goal of fistula management is to resolve and prevent sepsis, eradicate the fistula, prevent recurrence, and ensure continence. Laser Ablation of Fistula Tract (LAFT) offers a viable alternative sphincter-saving modality. Patient and methods:In this study, we performed a randomized controlled trial to evaluate the safety and efficacy of laser ablation as a treatment for transsphincteric fistulas. This study was conducted at Ain Shams University hospitals from June 2019 to June 2022 and included eighty patients with cryptoglandular transsphincteric fistulas who had undergone previous drainage and seton, they were divided into two groups. The first group (Group A) underwent fistulectomy with subsequent sphincteroplasty while the second group (Group B) underwent laser ablation of the fistula tract. Follow-up was scheduled in the outpatient clinic at 1 and 2 weeks and 1, 3, and 6 months postoperatively. The Cleveland Clinic Florida Fecal Incontinence CCF-FI score and the visual analog scale (VAS) score were recorded at each visit. Results:The results of the study showed that the laser ablation of the fistula track technique is a safe and effective sphincter-saving modality for transsphincteric fistula management with acceptable healing rates. The technique also carries the advantages of a short learning curve, reduced hospital stay, and minimal risk of incontinence. Conclusion:Our study found that laser ablation is a safe and effective treatment option for transsphincteric fistulas. Preliminary seton insertion may have a positive impact on postoperative outcome. However, there is a need for further research to evaluate the long-term outcomes..