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Sphincter-saving therapy for fistula-in-ano: long-term follow-up after FiLaC®

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Abstract

Background

The treatment of anal fistula remains a challenge between maintaining continence and radical surgery to prevent recurrence. Fistula-tract Laser Closure (FiLaC®) is a sphincter-saving technique using a radial emitting laser fibre to close the fistula tract. The aim of this study was to report long-term outcomes in patients who received FiLaC® therapy for transsphincteric and intersphincteric anal fistula between January 2011 and December 2017.

Methods

A retrospective study was performed on patients who were treated with FiLaC®- for a transsphincteric and intersphincteric anal fistula at our institution between January 2011 and December 2017. In all patients, the FiLaC® procedure was combined with a closure of the internal orifice using a simple 3-0 Z stitch. Patient characteristics, previous proctological history, healing rates, failures and postoperative continence were investigated.

Results

The study included 83 patients [mean age 50.01 ± 14.59 years. 64 (77.1%) males] with a mean follow-up period of 41.99 (± 21.59) months (range 4–87 months). Thirteen patients (15.7%) had a recurrent fistula. 65 patients (78.3%) had undergone prior abscess drainage with insertion of a seton. The primary healing rate was 74.7% (62 of 83 patients) overall. Eleven (13.3%) of the 21 patients (25.3%) who failed FiLaC®-therapy underwent a second operation. In eight cases, Re-FiLaC® and in three cases, fistulectomy with closure of the internal orifice was performed. Afterwards 6 (54.5%) of these 11 patients could be considered cured: 3 who had fistulectomy and three who had Re-FiLaC® treatment. The overall healing rate after second FiLaC® was 78.3% (65 of 83 patients) while the overall healing rate for FiLaC® therapy combined with any second procedure was 81.9% (68 of 83 patients). The follow-up period in this group of 11 patients who received re-operation was 38 months (range 13–84 months). Changes in continence occurred in eight patients (9.6%). No patient reported major incontinence postoperatively.

Conclusions

The FiLaC® procedure is associated with good healing rates in long-term follow-up and should be considered as a treatment option for transsphincteric and intersphincteric anal fistulae, especially due to the low complication rate and low risk of sphincter injury.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Marien Hospital Witten, Teaching hospital of the Ruhr University Bochum, Marienplatz 2, 58452, Witten, Germany

    A. Wolicki, P. Jäger, T. Deska & M. Senkal

Authors
  1. A. Wolicki
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  2. P. Jäger
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  3. T. Deska
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  4. M. Senkal
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Corresponding author

Correspondence to A. Wolicki.

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Conflict of interest

Author Dr. med. Thomas Deska has received travel grants and speaker honoraria from Company Biolitec biomedical GmbH Germany.

Ethics approval

The study was accepted by the local ethics committee of the Ruhr University Bochum.

Informed consent

All patients undergoing the FiLaC-procedure provided informed consent.

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Wolicki, A., Jäger, P., Deska, T. et al. Sphincter-saving therapy for fistula-in-ano: long-term follow-up after FiLaC®. Tech Coloproctol 25, 177–184 (2021). https://doi.org/10.1007/s10151-020-02332-4

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  • DOI: https://doi.org/10.1007/s10151-020-02332-4

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