Impact of the method of internal opening closure of anal fistula on outcomes after laser fistula coagulation. Preliminary results of randomized clinical trial

Abstract

AIM: to estimate the outcomes after fistula laser coagulation for transsphincteric anal fistulas.PATIENTS AND METHODS: a prospective randomized single-center study included 42 patients with transsphincteric anal fistulas, 36 (85.7%) of them had a follow-up > 3 months. Nineteen patients were randomized to the group of laser thermocoagulation of the fistula track (diode laser 1560 nm) combined with ligation of intersphincteric fistula track (LC + LIFT). Seventeen patients were randomized to the group of laser thermocoagulation of the fistula combined with closure of internal fistula opening by advancement flap (LC + AF). Mean follow-up period was 6.5 months. Perioperatively (before surgery, 1 and 2 months after surgery), patients underwent ultrasound to assess fistula healing and early detection of recurrence.RESULTS: no intraoperative and early postoperative complications occurred. In the LC + LIFT group, healing rate was 89,5% (17/19 patients), in the LC + AF group — 64.7% (11/17patients). Endorectal ultrasound confirmed healing or early recurrence. No significant factors affecting recurrence rate were identified in both groups.CONCLUSION: treatment of transsphincteric anal fistulas by LC + LIFT showed better results compared with LC + AF technique. However, further recruitment of patients into study groups is required with evaluation of late results.