Anal Fistula Laser Closure: the length of fistula is the Achilles’ heel

A. Lauretta, N. Falco, E. Stocco, R. Bellomo, A. Infantino

Research output: Contribution to journalArticle

Abstract

Background: Laser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing. Methods: A retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470 nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of fistula tract was investigated. A successful outcome was defined by the complete healing of the surgical wound and external opening for at least 6 months. Results: Thirty patients (16 males, median age 52 years, range 26–72 years) underwent laser fistula closure between January 2015 and December 2016. Cure was achieved in 10 patients (33.3%). The mean follow-up was 11.30 months (range 6–24 months). Patients with persistent or recurrent fistula were offered repeat surgery. Eventually 4 underwent laser treatment once more. Two patients were cured leading to an overall healing rate of 40% (12 out of 30). Only 4 minor complications occurred (13.3%). No worsening of anal continence was registered. Only fistula length had a statistically significant correlation with successful treatment. Fistula tracts shorter than 30 mm were associated with a primary healing rate of 58.3% while tracts longer than 30 mm were cured in only 16.6% of cases (p < 0.02). Conclusions: Laser closure is a safe and effective treatment for transphinteric anal fistula. The fistula length is the only significant prognostic factor when closing anal fistulas exclusively with laser: shorter fistulas have a better outcome.

Original languageEnglish
Pages (from-to)933
Number of pages939
JournalTechniques in Coloproctology
Volume22
Issue number12
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Rectal Fistula
Fistula
Lasers
Therapeutics
Semiconductor Lasers
Reoperation
Patient Selection
Observational Studies
Retrospective Studies

Keywords

  • Anal fistula
  • Laser
  • Prognostic factors
  • Sphincter-saving technique

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Anal Fistula Laser Closure : the length of fistula is the Achilles’ heel. / Lauretta, A.; Falco, N.; Stocco, E.; Bellomo, R.; Infantino, A.

In: Techniques in Coloproctology, Vol. 22, No. 12, 01.01.2018, p. 933.

Research output: Contribution to journalArticle

Lauretta, A. ; Falco, N. ; Stocco, E. ; Bellomo, R. ; Infantino, A. / Anal Fistula Laser Closure : the length of fistula is the Achilles’ heel. In: Techniques in Coloproctology. 2018 ; Vol. 22, No. 12. pp. 933.
@article{dfd38ee23e4e49d8931848cb2dfb94e0,
title = "Anal Fistula Laser Closure: the length of fistula is the Achilles’ heel",
abstract = "Background: Laser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing. Methods: A retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470 nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of fistula tract was investigated. A successful outcome was defined by the complete healing of the surgical wound and external opening for at least 6 months. Results: Thirty patients (16 males, median age 52 years, range 26–72 years) underwent laser fistula closure between January 2015 and December 2016. Cure was achieved in 10 patients (33.3{\%}). The mean follow-up was 11.30 months (range 6–24 months). Patients with persistent or recurrent fistula were offered repeat surgery. Eventually 4 underwent laser treatment once more. Two patients were cured leading to an overall healing rate of 40{\%} (12 out of 30). Only 4 minor complications occurred (13.3{\%}). No worsening of anal continence was registered. Only fistula length had a statistically significant correlation with successful treatment. Fistula tracts shorter than 30 mm were associated with a primary healing rate of 58.3{\%} while tracts longer than 30 mm were cured in only 16.6{\%} of cases (p < 0.02). Conclusions: Laser closure is a safe and effective treatment for transphinteric anal fistula. The fistula length is the only significant prognostic factor when closing anal fistulas exclusively with laser: shorter fistulas have a better outcome.",
keywords = "Anal fistula, Laser, Prognostic factors, Sphincter-saving technique",
author = "A. Lauretta and N. Falco and E. Stocco and R. Bellomo and A. Infantino",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s10151-018-1885-z",
language = "English",
volume = "22",
pages = "933",
journal = "Techniques in Coloproctology",
issn = "1123-6337",
publisher = "Springer-Verlag Italia s.r.l.",
number = "12",

}

TY - JOUR

T1 - Anal Fistula Laser Closure

T2 - the length of fistula is the Achilles’ heel

AU - Lauretta, A.

AU - Falco, N.

AU - Stocco, E.

AU - Bellomo, R.

AU - Infantino, A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Laser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing. Methods: A retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470 nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of fistula tract was investigated. A successful outcome was defined by the complete healing of the surgical wound and external opening for at least 6 months. Results: Thirty patients (16 males, median age 52 years, range 26–72 years) underwent laser fistula closure between January 2015 and December 2016. Cure was achieved in 10 patients (33.3%). The mean follow-up was 11.30 months (range 6–24 months). Patients with persistent or recurrent fistula were offered repeat surgery. Eventually 4 underwent laser treatment once more. Two patients were cured leading to an overall healing rate of 40% (12 out of 30). Only 4 minor complications occurred (13.3%). No worsening of anal continence was registered. Only fistula length had a statistically significant correlation with successful treatment. Fistula tracts shorter than 30 mm were associated with a primary healing rate of 58.3% while tracts longer than 30 mm were cured in only 16.6% of cases (p < 0.02). Conclusions: Laser closure is a safe and effective treatment for transphinteric anal fistula. The fistula length is the only significant prognostic factor when closing anal fistulas exclusively with laser: shorter fistulas have a better outcome.

AB - Background: Laser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing. Methods: A retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470 nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of fistula tract was investigated. A successful outcome was defined by the complete healing of the surgical wound and external opening for at least 6 months. Results: Thirty patients (16 males, median age 52 years, range 26–72 years) underwent laser fistula closure between January 2015 and December 2016. Cure was achieved in 10 patients (33.3%). The mean follow-up was 11.30 months (range 6–24 months). Patients with persistent or recurrent fistula were offered repeat surgery. Eventually 4 underwent laser treatment once more. Two patients were cured leading to an overall healing rate of 40% (12 out of 30). Only 4 minor complications occurred (13.3%). No worsening of anal continence was registered. Only fistula length had a statistically significant correlation with successful treatment. Fistula tracts shorter than 30 mm were associated with a primary healing rate of 58.3% while tracts longer than 30 mm were cured in only 16.6% of cases (p < 0.02). Conclusions: Laser closure is a safe and effective treatment for transphinteric anal fistula. The fistula length is the only significant prognostic factor when closing anal fistulas exclusively with laser: shorter fistulas have a better outcome.

KW - Anal fistula

KW - Laser

KW - Prognostic factors

KW - Sphincter-saving technique

UR - http://www.scopus.com/inward/record.url?scp=85058066985&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058066985&partnerID=8YFLogxK

U2 - 10.1007/s10151-018-1885-z

DO - 10.1007/s10151-018-1885-z

M3 - Article

VL - 22

SP - 933

JO - Techniques in Coloproctology

JF - Techniques in Coloproctology

SN - 1123-6337

IS - 12

ER -