Laser ablation of fistula tract (LAFT) and complex fistula-in-ano: “the ideal indication” is becoming clearer…

Bonnechose, Gregoire de; Lefèvre, Jérémie H.; Aubert, M; Lemarchand, Nicolas; Fathallah, Nadia; Pommaret, Elise; Soudan, D.; Spindler, Louise; Parades, Vincent de

doi:10.1007/s10151-020-02203-y

Cited by 18 publications

(31 citation statements)

References 16 publications

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“…This is so because unlike fistulotomy, which can be safely done in low fistulae with a success rate of 90%-98%, 18 most sphincter-saving procedures have a success rate of 30%-68%. 1,15,[19][20][21][22][23][24][25][26][27] Therefore, overestimation of sphincter involvement can lead to selection of a surgical procedure with a lower success rate.…”

Section: Assessing the Extent Of Sphincter Involvement: Mrimentioning

confidence: 99%

<p>Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions</p>

Garg¹,

Sodhi²,

Garg³

2020

CEG

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Anal fistulae can be a very difficult disease to manage. The management of complex fistulae is even more challenging. The risk to the fecal continence mechanism due to damage to the anal sphincters and refractoriness to the treatment (high recurrence rate) pose the two biggest challenges in the management of this disease. Apart from these, there are several other challenges in the treatment of complex fistulae. The intriguing and uphill task is that satisfactory solutions to most of these challenges are still not known, and there is hardly any consensus on whatever treatment solutions are available. To summarize, there is no gold-standard treatment available for treating complex anal fistulae, and the search for a satisfactory treatment option is still on. In this review, the endeavor has been to discuss and highlight recent path-breaking updates in the management of complex anal fistulae.

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Section: Assessing the Extent Of Sphincter Involvement: Mrimentioning

confidence: 99%

<p>Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions</p>

Garg¹,

Sodhi²,

Garg³

2020

CEG

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“…Эффективность аблации эпителиальной результативность может быть не столь убедительной, что, возможно, объясняет определенную долю рецидивов [23,24]. Ряд авторов не рекомендуют использовать методику FiLaC ® при свищах с диаметром хода более 5 мм, наличием затеков по ходу свища, при протяженности свищевого хода менее 4 см, при низких свищах заднего прохода, а также при наличии «незрелого» свища или при активном воспалении окружающих тканей [22][23][24][25][26]. G. de Bonnechose и соавт.…”

Section: состояние проблемыunclassified

“…G. de Bonnechose и соавт. [25] опубликовали данные о заживлении свищей прямой кишки после лазерной аблации в 44,6 % случаев (на всю группу), при этом свищи с широким внутренним отверстием заживали лишь в 15 % случаев, в то время как при наличии узкого внутреннего отверстия частота заживления составляла 49 %.…”

Section: состояние проблемыunclassified

“…de Bonnechose и соавт. [25] в своем исследовании не стандартизировали процедуру в соответствии с количеством энергии, приходящейся на квадратный сантиметр стенки свищевого хода. Тем не менее когда они проанализировали общее количество затраченной на процедуру энергии, то установили, что при общей энергозатрате 400 Дж частота рецидивов была выше, чем при энергозатрате более 400 Дж (65 % против 32 % соответственно).…”

Section: состояние проблемыunclassified

“…Тем не менее когда они проанализировали общее количество затраченной на процедуру энергии, то установили, что при общей энергозатрате 400 Дж частота рецидивов была выше, чем при энергозатрате более 400 Дж (65 % против 32 % соответственно). Подведение большего количества энергии к стенке свища может привести к ожогу окружающих тканей и увеличению диаметра свищевого хода [25]. С другой стороны, недостаточное количество энергии не позволяет надежно выполнить аблацию слизистой выстилки свищевого хода.…”

Section: состояние проблемыunclassified

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Evolution of treatment for rectal fistula: from resection to FiLaC® laser ablation

Атрощенко

Kiselev

Pozdnyakov

et al. 2021

Onkol. koloproktol.

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Rectal fistula – one of the most common coloproctological diseases. Annually, thousands of patients with anal fistula have had treated around the world. Treatment of this disease is an actual problem in coloproctology nowadays due to the high frequency of recurrence and anal incontinency. The chronic persistent perianal suppuration and multiple surgical interventions the main predictor of emergence of the anal incontinence, which could be achieve almost 50 %, according the literature data. The risk of emergence the anal incontinence is particularly high in the treatment of complex fistulas. Therefore, the problem of complex rectal fistulas treating remains an actual task in the clinical practice of a coloproctologist.

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Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double‐blinded randomized controlled trial

Low,

Rajandram,

Aziz

et al. 2024

World j. surg.

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BackgroundPrior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient‐reported outcomes, such as postoperative pain, which could influence surgical choice.ObjectiveTo compare pain scores at 6 and 24 h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula.DesignProspective, double‐blinded randomized controlled trial.SettingsA quaternary hospital in Malaysia.PatientsPatients aged 18–75 years with high transsphincteric fistulas.InterventionFistula laser closure versus ligation of the fistula tract (LIFT) treatment.Main Outcome MeasuresPain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi‐square, Fisher's exact test, student t‐test, or Mann–Whitney with p < 0.05 denoting statistical significance.ResultsFifty‐six patients were recruited (laser, n = 28, LIFT, n = 28). Median pain scores for laser versus LIFT at 6 h postoperatively were 1.0 versus 2.0 (Rest, p = 0.213) and 3.0 versus 4.0 (Movement, p = 0.448), respectively. At 24 h, this reduced to 2.5 in both arms at rest (p = 0.842) but increased to 4.8 versus 3.5 on movement (p = 0.383). Median operative time for laser was significantly shorter (32.5 min) than LIFT (p < 0.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, p = 0.181) but treatment failure was similar (54% vs. 50%, p = 0.71). No patients developed postoperative incontinence. Mean SF‐36 scores increased from baseline (67.1 ± 17.0; 95% CI 63.6–82.4 vs. 71.3 ± 11.4; 95% CI 64.0–75.0) to 6 months postoperatively (77.7 ± 21.0; 95% CI 57.0–80.3 vs. 74.0 ± 14.3; 95% CI 67.6–81.4) regardless of the type of surgery (P > 0.05).LimitationsPatients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy.ConclusionLaser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL.Trial RegistrationClinicalTrials.gov: NCT06212739.

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Laser ablation of fistula tract (LAFT) and complex fistula-in-ano: “the ideal indication” is becoming clearer…

Cited by 18 publications

References 16 publications

<p>Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions</p>

<p>Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions</p>

Evolution of treatment for rectal fistula: from resection to FiLaC® laser ablation

Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double‐blinded randomized controlled trial

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