Factors Influencing Healing and Recurrence After Laser assisted anal fistula surgery. A prospective observational study
DOI:
https://doi.org/10.31149/ijimm.v4i2.2650Keywords:
Assess, Technique Surgical, Post-Surgery, Complications, Outcomes, Laser, SurgeryAbstract
The study will attempt to assess the aspects that contribute towards the success rates of laser fistula surgeries to 110 patients undergoing the procedure in various hospitals in Iraq in 2024 to 2025. The prospective observational design was used, which made it easy to collect systematic data on the demographics of the patients, clinical history, surgery, and post-surgery outcomes. The surgery was done with the laser technique in spinal anesthesia, with variables of age, gender, duration of the symptoms, and past surgical history recorded. The evaluation of outcomes was done at specific follow-ups, 1 week, 1 month, and 3 months after surgery. The success rate was the main outcome measure, which was complete healing of the fistula with no recurrence in three months. Post-surgery complications were also counted and reported in a systematic manner as secondary outcomes. Primary results revealed that it had a success rate of 87.3 per cent and a complication rate of 27.3 per cent. Recurrence and mild infection had reported as the most common complications, which were both manageable. The analysis of logistic regression revealed that the risk factors that are significant risk factors of complications were increasing age, longer time of symptoms before surgery, and lower laser energy settings. In particular, one year of age corresponded to an increased risk of developing complications, and it is essential to consider the demographics of patients during surgery to perform it. The facts indicate that laser fistula surgery can be effective; however, the obtained data indicate that special attention to the personal aspects of the patient and the technical environment is essential to maximize the effect. More may be known about these associations in the future, and the possibility of targeting solutions to improve the efficacy of surgeries. The study will provide a useful insight into the best practices in the management of anal fistulas, using laser surgery, and eventually will eventually help improve patient care in the Iraqi healthcare context.
References
[1] Quality of life with anal fistula. Owen HA, Buchanan GN, Schizas A, Cohen R, Williams AB. Ann R Coll Surg Engl. 2016;98:334–338. doi: 10.1308/rcsann.2016.0136. [DOI] [PMC free article] [PubMed] [Google Scholar]
[2] Practice parameters for the management of perianal abscess and fistula-in-ano. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD. Dis Colon Rectum. 2011;54:1465–1474. doi: 10.1097/DCR.0b013e31823122b3. [DOI] [PubMed] [Google Scholar]
[3] Long-term outcome of the Surgisis® (Biodesign®) anal fistula plug for complex cryptoglandular and Crohn's fistulas. Aho Fält U, Zawadzki A, Starck M, Bohe M, Johnson LB. Colorectal Dis. 2021;23:178–185. doi: 10.1111/Codi 15429. [DOI] [PMC free article] [PubMed] [Google Scholar]
[4] Risk factors for anal fistula: a case-control study. Wang D, Yang G, Qiu J, Song Y, Wang L, Gao J, Wang C. Tech Coloproctol. 2014;18:635–639. doi: 10.1007/s10151-013-1111-y. [DOI] [PubMed] [Google Scholar]
[5] An assessment of the incidence of fistula-in-ano in four countries of the European Union. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D. Int J Colorectal Dis. 2007;22:1459–1462. doi: 10.1007/s00384-007-0334-7. [DOI] [PubMed] [Google Scholar]
[6] A classification of fistula-in-ano. Parks AG, Gordon PH, Hardcastle JD. Br J Surg. 1976;63:1–12. doi: 10.1002/bjs 1800630102. [DOI] [PubMed] [Google Scholar]
[7] Garg, Pankaj. "Is fistulotomy still the gold standard in the present era, and is it highly underutilized? An audit of 675 operated cases." International journal of surgery 56 (2018): 26-30.
[8] Xu, Yansong, and Weizhong Tang. "Ligation of the intersphincteric fistula tract is suitable for recurrent anal fistulas from follow‐up of 16 months." BioMed research international 2017, no. 1 (2017): 3152424.
[9] Podetta, M., Scarpa, C. R., Zufferey, G., Skala, K., Ris, F., Roche, B., & Buchs, N. C. (2019). Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure. International journal of colorectal disease, 34(1), 197-200.
[10] De Las Casas, S.G.; Alvarez-Gallego, M.; Martínez, J.A.G.; Alcolea, N.G.; Serrano, C.B.; Jiménez, A.U.; Arranz, M.D.M.; Martín, J.L.M.; Migueláñez, I.P. Management of perianal fistula in inflammatory bowel disease: Identification of prognostic factors associated with surgery. Langenbecks Arch. Surg. 2021, 406, 1181–1188. [Google Scholar] [CrossRef]
[11] Tjandra, D.; Garg, M.; Behrenbruch, C.; McCormick, J.; Simkin, P.; Prentice, R.; Trinh, A.; Al-Ani, A.; Vaughan, R.; Macrae, F.; et al. Review Article: Investigation and Management of Internal Fistulae in Crohn’s Disease. Aliment. Pharmacol. Ther. 2021, 53, 1064–1079. [Google Scholar]
[12] Schwartz, D.A.; Ghazi, L.J.; Regueiro, M.; Fichera, A.; Zoccali, M.; Ong, E.M.W.; Mortelé, K.J. Guidelines for the Multidisciplinary Management of Crohn’s Perianal Fistulas: Summary Statement. Inflamm. Bowel Dis. 2015, 21, 723–730. [Google Scholar] [CrossRef]
[13] Adegbola, S.O.; Dibley, L.; Sahnan, K.; Wade, T.; Verjee, A.; Sawyer, R.; Mannick, S.; McCluskey, D.; Yassin, N.; Phillips, R.K.S.; et al. Burden of Disease and Adaptation to Life in Patients with Crohn’s Perianal Fistula: A Qualitative Exploration. Health Qual. Life Outcomes 2020, 18, 370. [Google Scholar] [CrossRef] [PubMed]
[14] Singh, S.; Murad, M.H.; Fumery, M.; Sedano, R.; Jairath, V.; Panaccione, R.; Sandborn, W.J.; Ma, C. Comparative Efficacy and Safety of Biologic Therapies for Moderate-to-Severe Crohn’s Disease: A Systematic Review and Network Meta-Analysis. Lancet Gastroenterol. Hepatol. 2021, 6, 1002–1014. [Google Scholar] [CrossRef] [PubMed]
[15] Legué, C.; Brochard, C.; Bessi, G.; Wallenhorst, T.; Dewitte, M.; Siproudhis, L.; Bouguen, G. Outcomes of Perianal Fistulising Crohn’s Disease Following Anti-TNFα Treatment Discontinuation. Inflamm. Bowel Dis. 2018, 24, 1107–1113. [Google Scholar] [CrossRef] [PubMed]
[16] H. Dudukgian and H. Abcarian, "Why do we have so much trouble treating anal fistula? " World J. Gastroenterol., vol. 17, no. 28, pp. 3292–3296, 2011.
[17] S. K. Narang, K. Keogh, N. N. Alam, S. Pathak, I. R. Daniels, and N. J. Smart, "A systematic review of new treatments for cryptoglandular fistula in ano," Surgeon, vol. 15, pp. 30–39, 2017.
[18] Wilhelm, "A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe," Tech Coloproctol, vol. 15, pp. 445–449, 2011.
[19] Wilhelm, A. Fiebig, and M. Krawczak, "Five years of experience with the FiLaC™ laser for fistula-in-ano management: long-term follow-up from a single institution," Tech Coloproctol, vol. 21, no. 4, pp. 269–276, 2017. [Online]. Available https://doi.org/10.1007/s10151-017-1599-7
[20] P. Giamundo, M. Geraci, L. Tibaldi, and M. Valente, "Closure of fistula-in-ano with laser - FiLaC™: an effective novel sphincter-saving procedure for complex disease," Colorectal Dis., vol. 16, no. 2, pp. 110–115, 2014.
[21] S. O. Adegbola, K. Sahnan, G. Pellino, et al., "Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review," Tech Coloproctol, vol. 21, pp. 775, 2017.
[22] L. D. Carvalho, E. F. Alves Filho, R. S. M. D. Alcantara, and M. D. S. Barreto, "FILAC—Fistula—tract laser closure: a sphincter-preserving procedure for the treatment of complex anal fistulas," J. Coloproctol., vol. 37, no. 2, pp. 160–162, 2017.
[23] Slutzki S, Abramsohn R, Bogokowsky H. Carbon dioxide laser in the treatment of high anal fistula. Am J Surg. 1981;141:395–6. doi: 10.1016/0002-9610(81)90207-5. [DOI] [PubMed] [Google Scholar]
[24] Giamundo P, Esercizio L, Geraci M, Tibaldi L, Valente M. Fistula-tract Laser Closure (FiLaCTM): long-term results and new operative strategies. Tech Coloproctol. 2015;19:449–53. doi: 10.1007/s10151-015-1282-9. [DOI] [PubMed] [Google Scholar]
[25] Oztürk E, Gülcü B. Laser ablation of fistula tract: a sphincter-preserving method for treating fistula-in-ano. Dis Colon Rectum. 2014;57:360–4. doi: 10.1097/DCR.0000000000000067. [DOI] [PubMed] [Google Scholar]
[26] Giamundo P, Geraci M, Tibaldi L, Valente M. Closure of fistula-in-ano with laser-FiLaCTM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis. 2014;16:110–5. doi: 10.1111/Codi 12440. [DOI] [PubMed] [Google Scholar]
[27] Elfeki H, Shalaby M, Emile SH, Sakr A, Mikael M, Lundby L. A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol. 2020;24:265–74. doi: 10.1007/s10151-020-02165-1. [DOI] [PubMed] [Google Scholar]
[28] Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaCTM laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol. 2017;21:269–76. doi: 10.1007/s10151-017-1599-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
[29] Yassin NA, Hammond TM, Lunniss PJ, Phillips RK. Ligation of the intersphincteric fistula tract in the management of anal fistula: a systematic review. Colorectal Dis. 2013;15:527–35. doi: 10.1111/Codi 12224. [DOI] [PubMed] [Google Scholar]
[30] Blumetti J, Abcarian A, Quinteros F, Chaudhry V, Prasad L, Abcarian H. Evolution of treatment of fistula in ano. World J Surg. 2012;36:1162–7. doi: 10.1007/s00268-012-1480-9. [DOI] [PubMed] [Google Scholar]
