The success of Laser Ablation of Fistula Tract (LAFT) Technique in Anal Fistula Treatment: Early results of a tertiary center.

Year 2021, Volume: 38 Issue: 2, 192 - 196, 03.04.2021

Ismail Tarım , Murat Derebey , Can Akgün , Vahit Mutlu , Fatih Atalay , Ayfer Polat

Abstract

Laser Ablation of the Fistula Tract (LAFT) is a newly defined technique for anal fistula treatment. Our aim in this study is to evaluate the effectiveness of the LAFT technique and to discuss the precise indications and limitations of the technique by sharing our own truths and mistakes over our early results. All patients with anal fistulas who were treated LAFT tecnique by same team from April 2019 until March 2020 at the our center, were evaluated in this study, retrospectively. While the patients who failed LAFT were included in the "Reccurrence after LAFT" group, the patients with successful LAFT were included in the "Healing" group. Differences between the groups were investigated. LAFT technique was applied to 19 patients in the specified period. Twelve (63%) of the cases were male and 7 (37%) were female, and the mean age was 45 ± 14.5. The mean postoperative follow-up time was 13 ± 3.4 months. 11 cases had undergone surgery at least once with the diagnosis of anal fistula. Loose seton was applied in only 4 (25%) cases. It was observed that only 7 (37%) patients recovered with the LAFT technique (Table 1). LAFT was found to be more successful in patients who had never been operated before (p = 0.048, Table 2). In conclusion, LAFT technique is more successful in primary anal fistula cases and this technique should definitely be among the surgical options for anal fistula treatment.

Keywords

Laser Ablation of the Fistula Tract, anal fistula, LAFT, fecal continence

References

• Limura, E., Giordano, P., 2015. Modern management of anal fistula. World J Gastroenterol. 7;21(1):12-20.
• Amato, A., Bottini, C., De Nardi, P., Giamundo, P., Lauretta, A., RealisLuc, A., Piloni, V., 2020. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol. 24(2):127-143.
• Garg, P., Sodhi, S.S., Garg, N., 2020. Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions. Clin Exp Gastroenterol. 11;13:555-567.
• Sammut, M., Skaife, P.,2020. The management of cryptoglandular fistula-in-ano. Br J Hosp Med (Lond). 2;81(1):1-9.
• Wilhelm, A., 2011. A new technique for sphincter-preserving anal fistula repair using a novel radiale mitting laser probe. Tech Coloproctol. 15(4):445-9.
• Oztürk, E., Gülcü, B., 2014. Laserablation of fistulatract: a sphincter-preserving method for treating fistula-in-ano. Dis Colon Rectum. 57(3):360-4.
• Wilhelm, A., Fiebig, A., Krawczak, M., 2017. Five years of experience with the FiLaC™ laser for fistula-in-anomanagement: long-termfollow-upfrom a singleinstitution. Tech Coloproctol. 21(4):269-276.
• Terzi, M.C., Agalar, C., Habip, S., Canda, A.E., Arslan, N.C., Obuz, F., 2018. Closing Perianal Fistulas Using a Laser: Long-TermResults in 103 Patients. Dis Colon Rectum. 61(5):599-603.
• Brabender, D.E., Moran, K.L., Brady, M., Carmichael, J.C., Mills, S., Pigazzi, A., Stamos, M.J., Jafari, M.D., 2020. Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study. Tech Coloproctol. 24(10):1071-1075.
• Donmez, T., Hatipoglu, E., 2017. Closure of fistula tract with FiLaC [TM] laser as a sphincter-preserving method in anal fistula treatment/[Anal Fistul Tedavisinde Sfinkter Koruyucu Yontem Olarak FiLaC [TM] Lazer Yontemiyle Fistul Traktinin Kapatilmasi]. Turkish J Colorectal Dis 27: 142–8.
• Giamundo, P., Geraci, M., Tibaldi, L., Valente, M., 2014. Closure of fistula-in-ano with laser--FiLaC™: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis. 16(2):110-5.
• Elfeki, H., Shalaby, M., Emile, S.H., Sakr, A., Mikael, M., Lundby, L., 2020. A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol. 24(4):265-274.
• Frountzas, M., Stergios, K., Nikolaou, C., Bellos, I., Schizas, D., Linardoutsos, D., Kontzoglou, K., Vaos, G., Williams, A.B., Toutouzas, K., 2020. Could FiLaC™ be effective in the treatment of anal fistulas? A systematic review of observational studies and proportional meta-analysis. Colorectal Dis. 23. Epub ahead of print.
• Stijns, J., vanLoon, Y.T., Clermonts, S.H.E.M., Gӧttgens, K.W., Wasowicz, D.K., Zimmerman D.D.E., 2019. Implementation of laserablation of fistulatract (LAFT) for perianal fistulas: do the results warrant continued application of this technique? Tech Coloproctol. 23(12):1127-1132.
• Parks, A.G., Gordon, P.H., Hardcastle, J.D., 1976. A classification of fistula-in-ano. Br J Surg 63: 1-12.
• Morris, J., Spencer, J.A., Ambrose, N.S., 2000. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics. 20(3):623-35.
• Lauretta, A., Falco, N., Stocco, E., Bellomo, R., Infantino, A., 2018. Anal Fistula Laser Closure: the length of fistula is the Achilles' heel. Tech Coloproctol. 22(12):933-939.