Long-term outcomes of laser ablation of fistula tract for fistula-in-ano: A considerable option in sphincter preservation

Abstract

BACKGROUND: Ablation of anal fistula tract using a radial laser-emitting probe is a sphincter-preserving technique. OBJECTIVE: The purpose of this study was to assess long-term outcomes of laser ablation of fistula tract. DESIGN: This was a retrospective analysis of the long-term outcomes of 100 patients who underwent laser ablation of fistula tract. SETTINGS: This was a single-center study from a tertiary center in Turkey. PATIENTS: All of the patients with fistula-in-ano were included. Exclusion criteria were the presence of perianal abscess, underlying Crohn's disease, fistula tract <2 cm, fistulas suitable for simple fistulotomy, and intersphincteric fistulas originated from posterior located chronic anal fissure. INTERVENTIONS: A probe housing a 15-watt laser emitting at a wavelength of 1470 nm and an energy level of 100 to 120 joule/cm was used. MAIN OUTCOME MEASURES: No discharge, no symptoms, and fibrotic scar on skin where previously an external opening was present were defined as overall complete healing. All results other than overall complete healing were accepted as failure. RESULTS: A total of 100 patients underwent laser ablation of fistula tract with a median age of 42 years (range, 21-83 y). The majority of them were men. The overall success rate was 62% (95% CI, 52%-71%) in a median follow-up time of 48 months (range, 6-56 mo). None of the patients experienced permanent major or minor anal incontinence. LIMITATIONS: The retrospective nature of this study is its main limitation. Other limitations consist of phone interview for follow-up of the majority of the patients, single-institution data, and the relatively small number of patients. CONCLUSIONS: Laser ablation of the fistula tract is a sphincter-preserving procedure with an acceptable long-term success rate.