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A systematic review and meta-analysis of the safety and efficacy of fistula laser closure

Abstract

Background

Fistula laser closure (FiLaC) is a novel sphincter-saving technique for the treatment of fistula-in-ano. The aim of this study was to assess the safety and efficacy of the FiLaC procedure.

Methods

Databases including PubMed/Medline, Scopus, Web of Science, and Embase were searched for articles assessing FiLaC. All studies including case series and comparative studies reporting the outcome of FiLaC in the treatment of fistula-in-ano were considered eligible. The main outcomes were healing rates of fistula laser closure, postoperative complications including incontinence, technical aspects of the procedure and failure of healing.

Results

Seven studies were included. There were a total of 454 patients, 69.1% with a transsphincteric fistula-in-ano and 35% with recurrent disease. The median age of the patients was 43 years (range 18–83 years). The median operation time was 18.3 min (range 6–32 min). With a median follow-up of 23.7 months, the weighed mean rate of primary healing was 67.3% and the overall success when FiLaC was reused was 69.7%. The weighted mean rate of complications was 4%, all of them were minor complications and the weighted mean rate of continence affection was 1% in the form of minor soiling.

Conclusions

FiLaC may be considered an effective and safe sphincter-saving technique for the treatment of fistula-in-ano with an acceptable, low, complication rate. However, well-designed randomized control trials comparing FiLaC with other techniques are required to substantiate the promising outcomes reported in this review.

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Funding

No funding was received for this study.

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Affiliations

Authors

Contributions

HE and LL designed the study. HE, MS, SHE, AMM and AS participated in data extraction, analysis, writing and drafting of the manuscript, LL critically revised the manuscript and all authors approved the final version.

Corresponding author

Correspondence to H. Elfeki.

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The authors declare no conflict of interest.

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This article does not contain any study with human participants or animals performed by any of the authors.

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For this type of study, formal consent is not required.

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

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Keywords

  • Anal fistula
  • Perianal fistula
  • Fistula-in-ano
  • FiLaC
  • Laser
  • Outcome