Short term Outcomes of Fistula Laser Closure (FILAC) as a Sphincter Sparing Technique Versus Fistulotomy with Immediate Sphincter Reconstruction (FISR) in High Trans-Sphincteric Fistula–in-ano; a Prospective Cohort Study

Abstract

Background:The challenge of treating high trans-sphincteric fistula-in-ano lies in preserving anal sphincter integrity whilst achieving complete eradication of the fistula tract. FILAC has been recently introduced as a sphincter-saving technique in high fistulas, but its efficiency is still questionable regarding rates of recurrence and fecal incontinence. Objectives: To review short term results of FILAC as a sphincter preserving technique in comparison with lay open fistulotomy plus immediate sphincter reconstruction (FISR) during treating high trans-sphincteric anal fistula.Patients and methods: This is a prospective cohort study which included 21 patients of FILAC and 22 patients of FISR in the period between April 2019 and April 2021 at Ain Shams University Hospitals. Both groups where compared to each other regarding several intra and post operative variants specially incidence of recurrence and fecal incontinence. Results:The mean age of study population is 42.05±6.91 years for group 1, and 40.18±7.28 for group 2. Wound took remarkably shorter time to heal in FILAC group (mean 13.67±2.20 days) versus 37.27±7.84 days in FISR group, P= 0.001. Patients who underwent FILAC technique experienced significantly lower pain score than those in the comparing group (mean 4.14±1.39 vs 6.50±1.06 respectively, P= 0.001. None of FILAC patients versus 5 cases (22.7%) of FISR group reported symptoms suggestive of incontinence (P= 0.048). Although recurrence was higher in FILAC group compared to FISR group (7 cases (33.3%) vs 4 cases (18.2%) respectively), it failed to prove statistical significance, P= 0.255. Conclusion:FILAC has proven superiority to FISR technique in terms of post-operative pain score, wound healing time and incidence of fecal incontinence in treating high trans-sphincteric anal fistula .However ,the incidence of recurrence was higher in FILAC group than FISR group without statistical significance. Further randomized clinical trials are encouraged to confirm our results.