Aim: Recurrence and anal incontinence, are the commonest complications associated after fistula surgery. Cause of recurrence has been attributed to the inability to find or tackle the internal opening. Various surgical procedures- both sphincter cutting and sphincter saving, have been used to manage the internal opening. The aim of our study was to develop a technique to achieve internal opening closure with separation of distal tract containing the cryptoglandular infection, followed by laser coagulation.
Method: A total of 31 patients with anal fistula underwent distal laser proximal modified SLOFT procedure. The patients were having either primary or recurrent intersphincteric or trans-sphincteric fistulas. The surgical technique opted for these patients were internal opening ablation with laser energy followed by primary closure of internal opening, distal tract was separated and laser coagulated to deal with cryptoglandular infection. Patients having suprasphincteric, extrasphincteric or high fistulas or fistulas with fistula tract length of less than four cms., were excluded in this study.
Result: Out of 73 patients with anal fistula fistula operated from April 2017 to March 2019. 42 patients underwent FiLaC procedure out of with 7 patients having recurrence indicating a success rate of 84%. Remaining 31 patients were taken for DLPS out of which 2 patients had recurrence leading to a better success rate of 93.6%.
Conclusion: Distal laser with proximal modified SLOFT appears to be a safe sphincter saving procedure for the treatment of inter-sphincteric and trans-sphincteric anal fistula where internal opening can be well defined. Results seem promising as per current data. This minimal invasive technique should be encouraged as a part of sphincter saving procedure for the treatment of fistula in ano.
Impact Factor
2022: 6.012
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