Closing Perianal Fistulas Using a Laser: Long-Term Results in 103 Patients

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Abstract

BACKGROUND:

Primary closure of the fistula tract using energy emitted by a radial fiber connected to a diode laser is a novel procedure for treating perianal fistulas.

OBJECTIVE:

The aim of this study was to determine the long-term effectiveness of this new technique.

DESIGN:

The surgical objective was to seal the fistula tract using laser energy.

SETTINGS:

The study was conducted at a single day-case surgery center.

PATIENTS:

Between April 2012 and June 2016, 103 consecutive patients with primary or recurrent perianal fistula underwent a laser closure procedure using a 12-watt laser emitting at a wavelength of 1470 nm.

MAIN OUTCOME MEASURES:

Patients were classified according to the Park classification, and healing was evaluated based on the perianal fistula disease severity score.

RESULTS:

Among the 103 patients treated using the laser closure procedure, 82 (80%) were men and 21 (20%) were women. The median age of the patients was 43 years (range, 18–78 y). Fifty-three patients (52%) had previous perianal fistula repair surgery. Based on the Park classification, 56 patients (54%) had intersphincteric fistula, 29 (28%) had transsphincteric fistula, 11 (11%) had suprasphincteric or extrasphincteric fistula, and 7 (7%) had superficial perianal fistula. Based on the perianal disease severity score, 41 patients (40%) obtained overall complete healing, 38 (37%) had persistent symptomatic drainage, 20 (19%) had slight drainage with minimal symptoms, and 4 (4%) had painful symptomatic drainage.

LIMITATIONS:

This was a retrospective analysis of noncomparative data with a lack of formal prospective continence assessment.

CONCLUSIONS:

Closure of perianal fistulas using a laser should be considered as a treatment option but with modest expectations. Although our complete healing rate was not as high as in earlier studies, this technique is a reasonable option with nearly no risk of sphincter damage when treating perianal fistulas. See Video Abstract at http://links.lww.com/DCR/A545.

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