Primary closure of complex fistula-in-ano with 980 nm diode Laser: a pilotprospective study: P162

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Aim:Treatment of high anal fistulas is challenging. Special attention has to paid not only to fistula tract eradication but also to continencepreservation. A new technique aiming atprimary closure of fistulas by means of Laser radiant energy is described.Method:With patients in lithotomy position the fistula tract and its internal opening are identified. A disposable flexible laser optic-fibre is introduced into the fistula tract through a Seldinger manoeuvre.Laser radiant energy at a power of 10 W is delivered within the lumen of the fistula while gently pulling the laser fibre out of the tract. Sequential shrinkage of fistula lumen occurs in a few seconds.Results:Four patients with complex fistulas were treated. Primary closure of the fistula tract was accomplished in all four patients. Symptoms and leakage disappeared within 4 weeks postoperatively. Temporary mild anismus was reported in two cases. At median follow-up of 5 months, no recurrence was reported. Closure of fistula tract was confirmed at endoanal ultrasound.Conclusion:The described laser technique seems to be a safe and effective means of closing complex fistulas avoiding the risk of anorectal incontinence. Longer-term follow-up and larger series are required to establish the real efficacy of thisprocedure.

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