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Efficacy and safety of FiLaC™ for perianal fistulizing Crohn’s disease: a systematic review and meta-analysis

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Abstract

Background

Most patients with perianal fistulizing Crohn’s disease (pfCD) present with complex types of perianal fistulas and need repetitive repair operations, resulting in a high risk of sphincter injury. Fistula-tract Laser Closure (FiLaC™) is a novel sphincter-saving technique that obliterates the fistula tract with a photothermal effect. The aim of the present systematic review and meta-analysis was to evaluate the efficacy and safety of FiLaC in pfCD.

Methods

This study was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, including PubMed, Embase, Cochrane Library and Wanfang Data were searched for published articles from January 2000 to June 2021. The clinicaltrials.gov website was searched for completed or ongoing trials on pfCD and FiLaC™. The references of each article were also searched for eligible data. The main outcome was the primary healing rate of the FiLaC™ procedure. Additionally, fecal incontinence was analyzed as the secondary outcome to evaluate the safety of FiLaC™.

Results

Six studies met the eligibility criteria and were included in the final analysis. All studies were published within the past 6 years and came from European countries. There were 50 pfCD patients recruited, and 31 patients’ fistulas were healed after FiLaC™. The pooled primary healing rate was 68% (95% CI 53.0–84.0%, I2 = 27%, p = 0.23). There was no major fecal incontinence after surgery.

Conclusions

These data suggest that FiLaC™ may be an effective and safe procedure for pfCD patients. However, the evidence is poor and there is a need for more high-quality prospective controlled studies with long-term follow-up before this minimally invasive technique is recommended for surgical treatment of pfCD.

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References

  1. Kotze PG, Shen B, Lightner A, Yamamoto T, Spinelli A, Ghosh S, Panaccione R (2018) Modern management of perianal fistulas in Crohn’s disease: future directions. Gut 67:1181–1194. https://doi.org/10.1136/gutjnl-2017-314918

    Article  CAS  PubMed  Google Scholar 

  2. Bouchard D, Pigot F, Staumont G, Siproudhis L, Abramowitz L, Benfredj P, Brochard C, Fathallah N, Faucheron JL, Higuero T, Panis Y, de Parades V, Vinson-Bonnet B, Laharie D (2018) Management of anoperineal lesions in Crohn’s disease: a French national society of coloproctology national consensus. Tech Coloproctol 22:905–917. https://doi.org/10.1007/s10151-018-1906-y

    Article  CAS  PubMed  Google Scholar 

  3. Ommer A, Herold A, Berg E, Furst A, Post S, Ruppert R, Schiedeck T, Schwandner O, Strittmatter B (2017) German S3 guidelines: anal abscess and fistula (second revised version). Langenbecks Arch Surg 402:191–201. https://doi.org/10.1007/s00423-017-1563-z

    Article  PubMed  Google Scholar 

  4. Cheung XC, Fahey T, Rogers AC, Pemberton JH, Kavanagh DO (2021) Surgical management of idiopathic perianal fistulas: a systematic review and meta-analysis. Dig Surg 38:104–119. https://doi.org/10.1159/000512652

    Article  PubMed  Google Scholar 

  5. Wilhelm A, Fiebig A, Krawczak M (2017) Five years of experience with the FiLaC laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol 21:269–276. https://doi.org/10.1007/s10151-017-1599-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Marref I, Spindler L, Aubert M, Lemarchand N, Fathallah N, Pommaret E, Soudan D, Pillant-le Moult H, Safa Far E, Fellous K, Crochet E, Mory B, Benfredj P, de Parades V (2019) The optimal indication for FiLaC((R)) is high trans-sphincteric fistula-in-ano: a prospective cohort of 69 consecutive patients. Tech Coloproctol 23:893–897. https://doi.org/10.1007/s10151-019-02077-9

    Article  CAS  PubMed  Google Scholar 

  7. Brabender DE, Moran KL, Brady M, Carmichael JC, Mills S, Pigazzi A, Stamos MJ, Jafari MD (2020) Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study. Tech Coloproctol 24:1071–1075. https://doi.org/10.1007/s10151-020-02281-y

    Article  CAS  PubMed  Google Scholar 

  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 16:110–115. https://doi.org/10.1111/codi.12440

    Article  CAS  PubMed  Google Scholar 

  9. Giamundo P, Esercizio L, Geraci M, Tibaldi L, Valente M (2015) Fistula-tract Laser Closure (FiLaC): long-term results and new operative strategies. Tech Coloproctol 19:449–453. https://doi.org/10.1007/s10151-015-1282-9

    Article  CAS  PubMed  Google Scholar 

  10. De Hous N, de Gheldere C, Van den Broeck S, Komen N (2019) FiLaC as a last, sphincter-preserving resort for complex perianal fistula. Tech Coloproctol 23:937–938. https://doi.org/10.1007/s10151-019-02070-2

    Article  PubMed  Google Scholar 

  11. Wolicki A, Jager P, Deska T, Senkal M (2021) Sphincter-saving therapy for fistula-in-ano: long-term follow-up after FiLaC((R)). Tech Coloproctol 25:177–184. https://doi.org/10.1007/s10151-020-02332-4

    Article  CAS  PubMed  Google Scholar 

  12. Nordholm-Carstensen A, Perregaard H, Hagen KB, Krarup PM (2021) Fistula laser closure (FiLaC) for fistula-in-ano-yet another technique with 50% healing rates? Int J Colorectal Dis. https://doi.org/10.1007/s00384-021-03932-8

    Article  PubMed  Google Scholar 

  13. Alam A, Lin F, Fathallah N, Pommaret E, Aubert M, Lemarchand N, Abbes L, Spindler L, Portal A, de Parades V (2020) FiLaC((R)) and Crohn’s disease perianal fistulas: a pilot study of 20 consecutive patients. Tech Coloproctol 24:75–78. https://doi.org/10.1007/s10151-019-02134-3

    Article  CAS  PubMed  Google Scholar 

  14. Feuerstein JD, Ho EY, Shmidt E, Singh H, Falck-Ytter Y, Sultan S, Terdiman JP, American Gastroenterological Association Institute Clinical Guidelines C (2021) AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn’s disease. Gastroenterology 160:2496–2508. https://doi.org/10.1053/j.gastro.2021.04.022

    Article  PubMed  Google Scholar 

  15. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–1405. https://doi.org/10.1056/NEJM199905063401804

    Article  CAS  PubMed  Google Scholar 

  16. Elfeki H, Shalaby M, Emile SH, Sakr A, Mikael M, Lundby L (2020) A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol 24:265–274. https://doi.org/10.1007/s10151-020-02165-1

    Article  CAS  PubMed  Google Scholar 

  17. Garcia-Olmo D, Van Assche G, Tagarro I, Diez MC, Richard MP, Khalid JM, van Dijk M, Bennett D, Hokkanen SRK, Panes J (2019) Prevalence of anal fistulas in Europe: systematic literature reviews and population-based database analysis. Adv Ther 36:3503–3518. https://doi.org/10.1007/s12325-019-01117-y

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kaminski JP, Zaghiyan K, Fleshner P (2017) Increasing experience of ligation of the intersphincteric fistula tract for patients with Crohn’s disease: what have we learned? Colorectal Dis 19:750–755. https://doi.org/10.1111/codi.13668

    Article  CAS  PubMed  Google Scholar 

  19. Stellingwerf ME, van Praag EM, Tozer PJ, Bemelman WA, Buskens CJ (2019) Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn’s high perianal fistulas. BJS Open 3:231–241. https://doi.org/10.1002/bjs5.50129

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Schwandner O (2013) Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn’s disease. Tech Coloproctol 17:221–225. https://doi.org/10.1007/s10151-012-0921-7

    Article  CAS  PubMed  Google Scholar 

  21. Garg P, Singh P (2017) Video-assisted anal fistula treatment (VAAFT) in cryptoglandular fistula-in-ano: a systematic review and proportional meta-analysis. Int J Surg 46:85–91. https://doi.org/10.1016/j.ijsu.2017.08.582

    Article  PubMed  Google Scholar 

  22. Bosca MM, Alos R, Maroto N, Gisbert JP, Beltran B, Chaparro M, Nos P, Minguez M, Hinojosa J (2020) Recommendations of the Crohn’s Disease and ulcerative colitis Spanish working group (GETECCU) for the treatment of perianal fistulas of Crohn’s disease. Gastroenterol Hepatol 43:155–168. https://doi.org/10.1016/j.gastrohep.2019.09.012

    Article  PubMed  Google Scholar 

  23. Nasseri Y, Cassella L, Berns M, Zaghiyan K, Cohen J (2016) The anal fistula plug in Crohn’s disease patients with fistula-in-ano: a systematic review. Colorectal Dis 18:351–356. https://doi.org/10.1111/codi.13268

    Article  CAS  PubMed  Google Scholar 

  24. Panes J, Garcia-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, Dignass A, Nachury M, Ferrante M, Kazemi-Shirazi L, Grimaud JC, de la Portilla F, Goldin E, Richard MP, Leselbaum A, Danese S, Collaborators ACSG (2016) Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial. Lancet 388:1281–1290. https://doi.org/10.1016/S0140-6736(16)31203-X

    Article  PubMed  Google Scholar 

  25. Frountzas M, Stergios K, Nikolaou C, Bellos I, Schizas D, Linardoutsos D, Kontzoglou K, Vaos G, Williams AB, 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. https://doi.org/10.1111/codi.15148

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350:876–885. https://doi.org/10.1056/NEJMoa030815

    Article  CAS  PubMed  Google Scholar 

  27. Wasmann KA, de Groof EJ, Stellingwerf ME, D’Haens GR, Ponsioen CY, Gecse KB, Dijkgraaf MGW, Gerhards MF, Jansen JM, Pronk A, van Tuyl SAC, Zimmerman DDE, Bruin KF, Spinelli A, Danese S, van der Bilt JDW, Mundt MW, Bemelman WA, Buskens CJ (2020) Treatment of perianal fistulas in crohn’s disease, seton versus anti-tnf versus surgical closure following anti-TNF [PISA]: a randomised controlled trial. J Crohns Colitis 14:1049–1056. https://doi.org/10.1093/ecco-jcc/jjaa004

    Article  PubMed  PubMed Central  Google Scholar 

  28. Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, Piloni V (2020) Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol 24:127–143. https://doi.org/10.1007/s10151-019-02144-1

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was financially supported by the Innovation Foundation of Shanghai Baoshan District Science and Technology Commission (No. 19-E-30).

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Author notes

  1. D. Cao, W. Li and X. Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

    D. Cao & Z. Cui

  2. School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    W. Li & Y. Ji

  3. Baoshan Branch, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    X. Wang & Z. Cui

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Correspondence to Z. Cui.

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Cao, D., Li, W., Ji, Y. et al. Efficacy and safety of FiLaC™ for perianal fistulizing Crohn’s disease: a systematic review and meta-analysis. Tech Coloproctol 26, 775–781 (2022). https://doi.org/10.1007/s10151-022-02682-1

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