Treatment of anal fistula with FiLaC®: results of a 10-year experience with 175 patients

“…Multiple fistula tracts and supra/extrasphincteric fistulas were risk factors for recurrence after VAAFT ( 7 ). Fistula laser closure (FiLaC®) is another effective sphincter-saving procedure for complex anal fistulas with a long-term success rate of 66.8% ( 8 ). A curved tract or a tract with diameters exceeding 4–5 mm might increase the failure rate ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…Fistula laser closure (FiLaC®) is another effective sphincter-saving procedure for complex anal fistulas with a long-term success rate of 66.8% ( 8 ). A curved tract or a tract with diameters exceeding 4–5 mm might increase the failure rate ( 8 ). In general, inadequate closure or elimination of the internal opening was probably the common defect of the above procedures, resulting in unsatisfactory success rates.…”

Section: Introductionmentioning

confidence: 99%

Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas

Hong

Gao

et al. 2022

Front. Surg.

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BackgroundThe optimal treatment of complex anal fistulas remains unclear, though many different sphincter-preserving procedures have been described. A minimally invasive technique with a better outcome is desired. The purpose of this study was to present a new technique—sphincter-preserving fistulectomy (SPF) and its clinical outcomes.Materials and MethodsA retrospective study was performed to compare the efficacy and outcomes of SPF with ligation of the intersphincteric fistula tract (LIFT) in the management of complex anal fistulas in regards to postoperative pain, complications, wound healing time, recurrence, overall success rate, fecal continence function, and quality of life. Continence function was evaluated using the Wexner incontinence scale and anal manometry. The fecal incontinence quality of life (FIQL) scale was used to assess patients' quality of life.ResultsFrom June 2020 to July 2021, 41 patients with 43 SPF procedures and 35 patients with 35 LIFT procedures were included. Postoperative pain was comparable between two groups. The morbidity rate and the mean wound healing time in the SPF group were lower than those in the LIFT group (2.3% vs. 48.6%, p < 0.001; 1.4 ± 0.3 vs. 1.7 ± 0.4 months, p = 0.001). At a mean follow-up duration of 11.4 ± 3.5 months in the SPF group and 10.7 ± 4.3 months in the LIFT group, SPF achieved a better overall success rate than LIFT (97.7% vs. 77.1%, p = 0.014). Three patients in the SPF group and 4 patients in the LIFT group who all underwent a simultaneous fistulotomy procedure complained new incontinence of flatus. There was no statistical difference between the two groups in regards to the Wexner scores (p = 0.790), the maximum resting anal canal pressure (p = 0.641), the maximum squeeze pressure (p = 0.289), and the FIQL scores including lifestyle (p = 0.188), coping (p = 0.188), depression (p = 0.850), and embarrassment (p = 0.910).ConclusionsSPF is a novel, safe, and effective minimally invasive technique for the management of complex anal fistulas, with a promising success rate and negligible impairment on continence. Future prospective studies are needed to evaluate the long-term outcomes of SPF.

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“…In the face of this challenge, recent years have seen the emergence of a myriad of minimally invasive surgical procedures/augmentations including fistula plug, 13 biosynthetic glue, 14 mucosal/rectal advancement flap, 15 LIFT (ligation of intersphincteric tract), 16 FiLaC (Laser Closure of Anal Fistula), 17 OTSC (over the scope clip) system, 18 and VAAFT 19 . Despite the increase in available options and, ostensibly, insight into the disease process, we are yet to witness a significant improvement in FIA cure rates, and it seems that more and longer‐term studies are needed to understand both the applications and efficacy of the new therapies 20 .…”

Section: Introductionmentioning

confidence: 99%

Long term efficacy of Video‐Assisted Anal Fistula Treatment (VAAFT) for complex fistula‐in‐ano: a single‐centre Australian experience

Hinksman

Naidu

Loon

et al. 2022

ANZ Journal of Surgery

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Background: Video-Assisted Anal Fistula Treatment (VAAFT) is a novel minimally invasive & sphincter-saving technique for treating complex fistula-in-ano involving endoscopic assessment & treatment of perianal fistula. This retrospective, non-randomized, observational study is the first Australian study of VAAFT. It is also the longest study of VAAFT to-date. Methods: From January 2014 to September 2019, 59 patients with a complex anal fistula were identified via MRI & underwent VAAFT. Fourteen patients had undergone previous definitive surgery for anal fistula. Specialized Karl Storz video equipment (fistuloscope) was used in the procedure. The rigid fistuloscope was used to directly visualize the fistula tract/s & internal opening. Closure of the internal opening was then performed. The fistula tract/s were then treated via fulguration. The external opening was kept patent & dressed. Patients were then followed up for a mean 59.5 months. Results: 67.9% (n = 38) of patients achieved primary healing (needing nil further intervention) at a median of 13 weeks. 12.5% (n = 7) experienced healing followed by recurrence while 19.6% (n = 11) experienced non-healing. Of the recurrence/non-healing groups, 11/18 underwent repeat VAAFT with healing occurring in 10/11 patients at a median of 7 weeks. The mean operating time was 41.1 min. There were no major complications & continence scores were not affected. Three patients were lost to follow up. Conclusion: VAAFT is both effective & safe for the treatment of complex fistula-in-ano. Its minimally invasive nature means that in the instance of recurrence or persistence, VAAFT can be repeated with minimal morbidity & reasonable likelihood of success.

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Treatment of anal fistula with FiLaC®: results of a 10-year experience with 175 patients

Cited by 21 publications

References 21 publications

Author’s reply to “Comments on “Treatment of anal fistula with FiLaC: results of a 10-year experience with 175 patients”” A. Anand, A. K. Jha, M. Kumar

Author’s reply to “Comments on “Treatment of anal fistula with FiLaC: results of a 10-year experience with 175 patients”” A. Anand, A. K. Jha, M. Kumar

Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas

Long term efficacy of Video‐Assisted Anal Fistula Treatment (VAAFT) for complex fistula‐in‐ano: a single‐centre Australian experience

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