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Fistula Laser Closure (FiLaC™) for fistula-in-ano—yet another technique with 50% healing rates?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Treatment of ano-cutaneous fistulas remains a therapeutic challenge. Fistula Laser Closure (FiLaC™) is a relatively new technique for the treatment of ano-cutaneous fistulas. This study aimed to determine the success rate of fistula closure using FiLaC™. Secondary endpoints included adverse events and patient characteristics associated with treatment success.

Methods

This was a retrospective cohort study of consecutive patients subjected to FiLaC™ at Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, between March 2017 and July 2019. All patients had a one-track fistula not suitable for fistulotomy. All were treated with a draining seton for at least 8 weeks prior to laser closure. Fistulas were ablated with a 360-degree emitting 12-watt 1470 nm laser probe. The inner fistula opening was closed with absorbable suture. All patients were followed with clinical examination including MRI or EAUS 1 year after the procedure.

Results

In total, 66 patients with 68 fistulas were included. Two patients had a high intersphincteric, 20 had low transsphincteric, 41 high transsphincteric and 5 had suprasphincteric fistulas. Fistula aetiology was cryptoglandular in 83.8%, whereas the rest were due to Crohn’s disease. Thirty-one (45.6%) were subjected to a second FiLaC™ procedure. Follow-up was median 19 months (12–26 months). Ultimately, 30 of 68 (44.1%) of the fistulas healed. No cases of incontinence following FiLaC™ were observed, but a single patient developed an abscess.

Conclusion

Fistula closure with FiLaC™ had success rates comparable to that of other sphincter-sparing techniques. The technique seems safe with respect to adverse events and risk of incontinence.

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Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark

    Andreas Nordholm-Carstensen, Kikke Bartholin Hagen & Peter-Martin Krarup

  2. Department of Surgery, Nordsjaellands Hospital, Hilleroed, Denmark

    Helene Perregaard

Authors
  1. Andreas Nordholm-Carstensen
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  2. Helene Perregaard
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  3. Kikke Bartholin Hagen
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  4. Peter-Martin Krarup
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Contributions

All listed authors have made substantial contributions to the conception or design of the work as well as the acquisition, analysis, or interpretation of data, drafted the work or revised it critically for important intellectual content, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Andreas Nordholm-Carstensen.

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According to Danish law, the study was reported to the Data Registration Authorities (j. no. P-2020-955). No ethics approval was needed.

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The authors declare no competing interests.

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Nordholm-Carstensen, A., Perregaard, H., Hagen, K.B. et al. Fistula Laser Closure (FiLaC™) for fistula-in-ano—yet another technique with 50% healing rates?. Int J Colorectal Dis 36, 1831–1837 (2021). https://doi.org/10.1007/s00384-021-03932-8

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  • DOI: https://doi.org/10.1007/s00384-021-03932-8

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