Laser ablation of fistula tract: A sphincter-preserving method for treating fistula-in-ano

Abstract

BACKGROUND: Lasers are used to treat various types of diseases, including fistula-in-ano. Until recently, the lasers used for this procedure radiated linear energy.

OBJECTIVE: To assess the short-term outcomes of patients undergoing ablation of fistula in-ano tract using a new laser that radiates circumferential energy.

DESIGN & SETTING: This study was approved by the local ethics committee at our institution. A 15-watt laser probe emitting at a wavelength of 1470 nm and producing 100-120 joules/cm of energy, was applied to 50 patients with fistula-in-ano under general anesthesia. Short-term outcomes, including success rate, complications, pain scores and time to return to normal daily activities, were evaluated. Success was defined as cessation of either the discharge or the patient's complaints.

RESULTS: Thirty-seven male and 13 female patients with a median age of 41 years (range: 23-83 years) were treated on an outpatient basis. Among these patients, 10 had inter-sphincteric fistulas, 34 had low transsphinteric fistulas and 6 had high transsphinteric fistulas. None of the patients required parenteral analgesics. The return to daily activities required a median of 7 days (range: 5-17 days). The median follow-up period was 12 months (range: 2-18 months). The success rate was 82%. Patients for whom the laser treatment was unsuccessful were later treated using traditional surgical methods.

LIMITATIONS: The retrospective review of the data and the fact that substantial follow-up was done by phone and not through physical examination are the main limiting factors in this study.

CONCLUSION: Laser ablation of fistula tract is a safe, effective, sphincter-preserving therapy that can be successfully performed by surgeons.