Treatment of anal fistulas with laser: theory and results

“ FiLaC ”Paolo Giamundo

MD, FEBSQ Coloproctology

Dept. Of General Surgery– Hospital S. Spirito, Bra (CN) Director SOS Colonproctologia

ASL CN2 – Region Piemonte – ITALYpgiamundo@gmail.com

FiLaC (Fistula Laser Closure)

Diode Laser, 1470 nm

Radial Fiber: acting at 360°

PhotoThermal effect< 45°C reversible hyperthermia45° – 63°C irreversible hyperthermia63° - 85°C Coartation, shrinkage,

denaturation85°-100°C Vaporization> 100°C Burning, Ablation

Effects of laser radiation on Human tissues

Total shrinkage of anal fistula around the radial fiber

Diode Laser 1470 nm

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Fistula Laser Closure (FiLaC)

Technical notes:

-No mucosal flaps to close the internal orifice

-Local or Epidural anesthesia

-Potential benefit by placing a draining seton in the fistula tract approximately 8 weeks before the FiLaC:

- closure of small secondary tracts?,- new epithelium and fibrosis in the fistula?- making the caliber of the fistula homogeneous?

Closure of Fistula-in-ano with laser: a viable option for the treatment of

recurrent anal fistulas

P. Giamundo MD, FEBSQ Coloproctology

Dept. of General Surgery (Dir: M. Valente) – Hospital S. Spirito –

Bra (CN) – ASL CN2 – Region Piemont, ITALY

Fistula Laser Closure (FiLaC):Patient and fistulas characteristics

Patients 45 (24 F, 21 M)

AGE: 46 yo (RANGE 18-78)

TYPE OF FISTULA: - Intersphincteric 7 (15%)

- Low tra ns-sphincteric 7 (15%)- Mid trans-sphincteric 19 (42%)- High trans-sphincteric 10 (22%)- Supra-sphincteric 2 (4%)

PREVIOUS LOOSE SETON: 24 patients (53%)

PREVIOUS FISTULA SURGERY: 35 patients (78%)

Fistula Laser Closure (FiLaC):

RESULTS (45 Patients)

MEAN OPERATIVE TIME (min.)20 (range 6-35)

MORBIDITY: - TEMPORARY TENESMUS (1 WEEK): 8 (18%) - URINARY RETENTION: 1 (

2%)- PAIN/ANISMUS ( 1 WEEK): 8 ( 18%)

- MODERATE BLEEDING 3 (6%)

MEDIAN HEALING TIME: 5 weeks ( range, 3-8)

FISTULAS CURED: 32 (71.1%)

MEDIAN FOLLOW-UP (months): 26 (range, 6-40)MEDIAN FOLLOW-UP (months): 26 (range, 6-40)

Kaplan-Meier: Freedom from failure or

recurrence

Kaplan-Meier: Freedom from failure or

recurrence

At 1 year the freedom from failure or recurrence was 79%(previous seton) and

62% (no seton). These rates did not change at longer follow-up

At 1 year the freedom from failure or recurrence was 79%(previous seton) and

62% (no seton). These rates did not change at longer follow-up

Fistula Laser Closure (FiLaC)CONCLUSIONSCONCLUSIONS 1

ADVANTAGES :

- SPHINCTER-SAVING

- EASY TO LEARN AND TO PERFORM

- REPEATABLE

- MINIMALLY-INVASIVE

- LOW MORBIDITY (no incontinence!)- HIGH PATIENTS’ COMPLIANCE

- Indicated IN: High FistulasRecurrent FistulasPatients with Low Resting anal toneMultiparous womenCrohn’s disease

- In complex fistulas with potential presence of abscesses and/orsecondary tracts, FiLaC should be performed as a second stage operation after the placement of a draining seton

Fistula Laser Closure (FiLaC)CONCLUSIONSCONCLUSIONS 2

“FiLaC” (Fistula Laser Closure) Can be considered as another viable‘surgical option’in the

treatment of selected patients with anal fistulas

“FiLaC” : Fistula Laser Closure

Paolo Giamundo, pgiamundo@gmail.com