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Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study

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Abstract

Background

Laser fistulectomy is a minimally invasive, sphincter-sparing procedure for treatment of anal fistula. In several studies, this method has been shown to be safe and effective, with reported success rates ranging from 40 to 88%. We hypothesized that with longer follow-up, these rates would decrease.

Methods

A retrospective case analysis assessing the effectiveness of laser fistulectomy in curing fistula-in-ano tracts within a cohort of patients at a single academic institution was conducted. All patients having laser ablation between March 2016 and July 2018 were analyzed. Cure of the fistula was determined by history and postoperative physical exam, and was defined as complete closure of fistula tract with resolution of symptoms. Secondary symptoms of fecal incontinence, infection, and pain were evaluated.

Results

Eighteen patients (10 males, mean age 41 ± 13 years) were analyzed. Transphincteric fistula was the most common type (67%, N = 12). The mean number of previous fistula procedures was 1.33 ± 1.64. There was a 22% (N = 4) success rate at an average postoperative follow-up period of 29 ± 8 months (range 18–46 months). Of those who failed, 64% (N = 9) had a subsequent fistula procedure. There were no cases of fecal incontinence, but 3 cases (17%) of postoperative infection were reported and 8 patients (44%) had a subjective increase in pain at first follow-up appointment.

Conclusions

Our data showed a much higher failure rate of laser fistulectomy compared to those reported in the literature. However, the small sample size, a large amount of heterogeneity in our patient population with a mixture of fistula types present, and various laser techniques applied decreased the power of this study.

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Authors and Affiliations

  1. Irvine Department of General Surgery, University of California, Irvine Medical Center, 333 City Blvd. West, Suite 850, Orange, CA, 92868, USA

    D. E. Brabender, K. L. Moran, M. Brady, J. C. Carmichael, S. Mills, A. Pigazzi, M. J. Stamos & M. D. Jafari

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  1. D. E. Brabender
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  2. K. L. Moran
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  3. M. Brady
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  4. J. C. Carmichael
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  5. S. Mills
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  6. A. Pigazzi
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  7. M. J. Stamos
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  8. M. D. Jafari
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Corresponding author

Correspondence to M. D. Jafari.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by internal review board at the University of California, Irvine and conformed to the ethical guidelines of the Helsinki Declaration (as revised in Tokyo 2004). No study advertising was made and no remuneration was offered.

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Brabender, D.E., Moran, K.L., Brady, M. et al. Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study. Tech Coloproctol 24, 1071–1075 (2020). https://doi.org/10.1007/s10151-020-02281-y

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  • DOI: https://doi.org/10.1007/s10151-020-02281-y

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