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Treatment of cryptoglandular fistulas with the fistula tract laser closure (FiLaC™) method in comparison with standard methods: first results of a multicenter retrospective comparative study in the Netherlands

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Abstract

Background

Current surgical closure techniques for sphincter-sparing treatment of high cryptoglandular fistulas in the Netherlands include the mucosal advancement flap procedure (MAF) and ligation of the intersphincteric fistula tract (LIFT). A relatively novel treatment is the fistula tract laser closure (FiLaC™) method. The aim of this study was to investigate the differences in healing and recurrence rates between FiLaC™ and current standard practices.

Methods

This multicenter retrospective cohort study included both primary and recurrent high cryptoglandular anorectal fistulas, treated with either FiLaC™ or standard methods (MAF or LIFT) between September 2015 and July 2020. Patients with extrasphincteric fistulas, Crohn’s disease, multiple fistulas, age < 18 years or missing data regarding healing time or recurrence were excluded. The primary outcomes were the clinical primary and secondary healing and recurrence rates. Primary healing was defined as a closed external opening without fluid discharge within 6 months of treatment on examination, while secondary healing was the same endpoint after secondary treatment. Secondary outcomes included healing time and complaints.

Results

A total of 162 high fistulas from 3 Dutch hospitals were included. Ninety-nine high fistulas were treated with FiLaC™ and 63 with either MAF or LIFT. There were no significant differences between FiLaC™ and MAF/LIFT in terms of clinical healing (55.6% versus 58.7%, p = .601), secondary healing (70.0% versus 69.2%, p = .950) or recurrence rates (49.5% versus 54%, p = .420), respectively. Median follow-up duration was 7.1 months in the FiLaC™ group (interquartile range [IQR] 4.1–14.4 months) versus 6 months in the control group (IQR 3.5–8.1 months).

Conclusions

FiLaC™ treatment of high anorectal fistulas does not appear to be inferior to MAF or LIFT. Based on these preliminary results, FiLaC™ can be considered as a worthwhile treatment option for high cryptoglandular fistulas. Prospective studies with a longer follow-up period and well-determined postoperative parameters such as complication rates, magnetic resonance imaging for confirmation of fistula healing, incontinence and quality of life are warranted.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Flevoziekenhuis, Almere, the Netherlands

    T. C. Sluckin, W. H. Gispen, S. Smeets, J. D. W. van der Bilt & R. Schouten

  2. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands

    J. Jongenotter, S. J. A. Hazen & R. M. Smeenk

Authors
  1. T. C. Sluckin
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  2. W. H. Gispen
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  3. J. Jongenotter
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  4. S. J. A. Hazen
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  5. S. Smeets
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  6. J. D. W. van der Bilt
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  7. R. M. Smeenk
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  8. R. Schouten
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Corresponding author

Correspondence to R. Schouten.

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The authors declare they have no conflict of interest.

Ethical approval

This study was approved by the local Institutional Review Board (IRB).

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Appendix

Appendix

See Tables 4, 5, and 6.

Table 4 Primary healing correlations
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Table 5 Recurrence rate correlations
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Table 6 Secondary healing correlations
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Sluckin, T.C., Gispen, W.H., Jongenotter, J. et al. Treatment of cryptoglandular fistulas with the fistula tract laser closure (FiLaC™) method in comparison with standard methods: first results of a multicenter retrospective comparative study in the Netherlands. Tech Coloproctol 26, 797–803 (2022). https://doi.org/10.1007/s10151-022-02644-7

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