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Techniques in Coloproctology

, Volume 15, Issue 4, pp 445–449 | Cite as

A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe

  • A. WilhelmEmail author
Technical Note

Abstract

Anal fistula repair still remains challenging. Up to 30% of fistulas persist after surgery despite many improvements in surgical skills and technique. One major reason for surgical failure is a persistent fistula track or remnants of the fistula epithelium which could not be removed during surgery. To overcome this problem, a novel technique was developed using a newly invented radial emitting laser probe (“FiLaC™”, Biolitec, Germany) to destroy the fistula epithelium and to simultaneously obliterate the remaining fistula track. In a pilot study, we operated on 11 patients with cryptoglandular anal fistula. All patients underwent previous surgery up to 6 times prior to definitive surgery. In the primary operation, the initial abscess was drained, the internal opening of the fistula identified and seton drainage placed. During fistula repair, we used the flap technique for conventional closure of the internal opening. The remaining fistula track was cleaned mechanically, the laser inserted into the track and energy applied homogeneously at a wavelength of 1,470 nm and 13 watt. While providing continuous retraction of the probe, the remaining epithelium was destroyed and the fistula track obliterated. The median follow-up was 7.4 months. Nine out of 11 fistulas showed primary healing (81.8%). Only one minor form of incontinence (limited soiling) was observed and no complications occurred. The use of a novel diode laser source and a radial emitting laser probe in addition to conventional surgery is a very promising new technique in sphincter-preserving anal fistula repair. The observed healing rate is high. Due to minimized trauma to the sphincter muscle, there are good short-term functional results without observable procedure-related complications.

Keywords

Anal fistula Repair Sphincter-preserving Laser 

Notes

Acknowledgments

I would like to thank Mr. Endrik Groenhoff (Biolitec, Germany) for the laser equipment as well as scientific and technical support and Professor Andrew Zbar for his critical review of the manuscript.

Conflict of interest

The author does not have a financial relationship to Biolitec, Germany. He does have full control of all primary data and he agrees to allow the journal to review the data if requested.

References

  1. 1.
    Litza EM, van Wijk JJ, Gosselink MP, Doornebosch P, Zommerman DDE, Schouten WR (2010) Seton drainage prior to transanal advancement flap repair: useful or not? Int J Colorectal Dis 25:1499–1502CrossRefGoogle Scholar
  2. 2.
    Ellis CN, Rostas JW, Greiner FG (2010) Long-term outcomes with the use of bioprosthetic plugs for the management of complex anal fistulas. Dis Colon Rectum 53:798–802PubMedCrossRefGoogle Scholar
  3. 3.
    Cirocchi R, Farinella E, La Mura F et al (2009) Fibrin glue in the treatment of anal fistula: a systematic review. Ann Surg Innov Res 14:3–12Google Scholar
  4. 4.
    Lunnis PJ, Sheffield JP, Talbot IC, Thomson JP, Phillips RKS (1995) Persistence of idiopathic anal fistula may be related to epithelialisation. Br J Surg 82:32–33CrossRefGoogle Scholar
  5. 5.
    Sygut A, Mik M, Trzcinski R, Dziki A (2010) How the location of the internal opening of anal fistulas affect the treatment results of primary trans-sphincteric fistulas. Langenbecks Arch Surg 395:1055–1060PubMedCrossRefGoogle Scholar
  6. 6.
    Roig JV, García-Armengol J, Jordán JC, Moro D, García-Granero E, Alós R (2009) Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas. Colorectal Dis 12:E145–E152PubMedGoogle Scholar
  7. 7.
    Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12PubMedCrossRefGoogle Scholar
  8. 8.
    Gale SS, Lee JN, Walsh ME, Wojnarowski DL, Comerota AJ (2010) A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg 52:645–650PubMedCrossRefGoogle Scholar
  9. 9.
    Doganci S, Demirkilic U (2010) Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg 40:254–259PubMedCrossRefGoogle Scholar
  10. 10.
    Meinero P, Mori L (2011) Video assisted anal fistula treatment (VAAFT): a novel sphincter saving procedure for the management of complex anal fistulas. Tech Coloproctol 15:215–253Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of General and Colorectal SurgerySt. Elisabeth Krankenhaus Köln-HohenlindCologneGermany
  2. 2.Enddarm- und Beckenbodenzentrum KölnCologneGermany

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