Comparative Study between Surgical Outcomes of Fistula Tract LASER Closure (FiLaCTM) Versus Fistulotomy with Primary Sphincter Reconstruction in Management of High Trans-Sphincteric Perianal Fistula

Abstract Background: Peri-anal fistula is avery common anal condition, its treatment is based on eradication of local sepsis and elimination of the fistula openings and tracts without affection of anal continence. Fistulotomy and primary sphincter reconstruction (lay open of the fistula tract with repair of sphincter muscle at the same session) is a well-known proce-dure which is widely utilized by surgeons to treat perianal fistula. Fistula Tract Laser Closure (FiLaCTM) is a recent sphincter-preserving procedure that is used inmanagement of peri-anal fistula. Aim of Study: To evaluate LASER closure of fistula tracts in the treatment of a high trans-sphincteric perianal fistula, FiLaCTM was compared to fistulotomy with primary sphincter reconstruction in terms of surgical results for 6-months period of follow-up. Patients and Methods: The present study was comparative prospective research involving 40 patients with high trans-sphincteric (non-branching) fistula from outpatient clinic at Ain Shams University. Study period was 9 months, including 6 months duration for follow-up, study began on 1st April 2021. Results: Six months of follow-up show statistically high substantial variations between groups regarding visual analog scale (VAS) score with high score in group (B) when comparing with group (A) (p>0.001).Operative time in group (A) ranged between 20-44 min. with mean ±S.D. 29.25±7.129 min. while in group (B) ranged between 25.48min. with mean ± S.D. 35.80±7.016min. between groups, there were statistically substantial variations (p=0.006). Early post-operative complications in group (A) show that 1 (5.0%) had infection while in group (B) 2 (10%) had bleeding and 2 (10%) had infection. No statistically substantial variations existed between the groups. Follow-up after 1 month show highly statistically significant differences between groups.
Correlation between recurrence or delayed healing and each of chronic disease and fistula duration, showed that there was negative statistically substantial variations between recurrence or delayed healing and each of DM (r=–0.404, p=0.010) and fistula duration (r=–0.640, p<0.001). Conclusion: Both fistula tract LASER closure (FiLaCTM) and sphincterotomy with primary sphincter reconstruction were secure and effective in treatinghigh trans-sphincteric perianal fistula. The fistula tract LASER closure was superior in terms of operative time, post-operative hospital stays, VAS score and Wexner score but in terms of success rate, sphinc-terotomy with primary sphincter reconstruction had higher success rate and lower recurrence.