Laser coagulation in combination with LIFT for transsphincteric anal fistulas
https://doi.org/10.33878/2073-7556-2021-20-2-35-41
Abstract
Aim: to improve the results of fistula treatment, to evaluate the effectiveness of the combined use of LIFT and FiLaC techniques.
Patients and methods: the study included 35 patients with transsphincter fistulas of cryptopglandular etiology involved more than 1/3 of the sphincter. All patients underwent surgery with laser energy (the laser conductor speed is 1 mm per second, the wavelength is 1470 nm, the radiation output is 13 W) after the LIFT procedure.
Results: the primary healing rate was 28/35 (80,0%). The patients who failed the combined procedure (cases of prolonged healing more than 3 months) underwent a second procedure ReFiLaC, which led to the closure of fistula in 2 of 3 patients. A median follow-up period was 10,2 months. No incontinence to solid and liquid stools was detected.
Conclusion: preliminary results of the study permits to assess the potential of the combined low-invasive approach for anal fistulas as positive.
About the Authors
S. V. Vasiliev
Pavlov First Saint Petersburg State Medical University; St-Petersburg City Hospital №9, City Center of Coloproctology
Russian Federation
Russian Federation
Sergei V. Vasiliev
6–8, Lev Tolstoy str., St-Petersburg, 197022, Russia,
18, Krestovskiy Ave., St-Petersburg, 197110, Russia
A. I. Nedozimovanyi
Pavlov First Saint Petersburg State Medical University; St-Petersburg City Hospital №9, City Center of Coloproctology
Russian Federation
Russian Federation
Anatolii I. Nedozimovanyi
6–8, Lev Tolstoy str., St-Petersburg, 197022, Russia,
18, Krestovskiy Ave., St-Petersburg, 197110, Russia
D. E. Popov
Pavlov First Saint Petersburg State Medical University; St-Petersburg City Hospital №9, City Center of Coloproctology
Russian Federation
Russian Federation
Dmitry E. Popov
6–8, Lev Tolstoy str., St-Petersburg, 197022, Russia,
18, Krestovskiy Ave., St-Petersburg, 197110, Russia
I. V. Gor
Pavlov First Saint Petersburg State Medical University; St-Petersburg City Hospital №9, City Center of Coloproctology
Russian Federation
Russian Federation
Ivan V. Gor
6–8, Lev Tolstoy str., St-Petersburg, 197022, Russia,
18, Krestovskiy Ave., St-Petersburg, 197110, Russia
T. A. Moshkova
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Tatiana A. Moshkova
6–8, Lev Tolstoy str., St-Petersburg, 197022, Russia,
References
1. Shelygin Yu.A. Klinicheskie rekomendacii. Koloproktologia. (pod red. Yu.A.Shelygina.) M.: GEOTAR Media, 2015;528. (in Russ.).
2. Zanotti C, Martinez-Puente C, Pascual I et al. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis. 2007;22(12):1459–62.
3. Eisenhammer S. A new approach to the anorectal fistulous abscess based on the high intermuscular lesion. Surg Gynecol Obstet. 1958;106:595–9.
4. Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961;1:463–9.
5. Vogel JD, Johnson EK, Morris AM, et al. Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2016;59(12):1117‐1133. DOI: 10.1097/DCR.0000000000000733
6. Ellis CN. Sphincter-preserving fistula management: what patients want. Dis Colon Rectum. 2010;53:1652–1655.
7. Steele SR, Kumar R, Feingold DL, et al. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54:1465–74.
8. Williams G, Williams A, Tozer P, et al. The treatment of anal fistula: second ACPGBI Position Statement–2018. Colorectal Dis. 2018;20:5–31.
9. Kostarev I.V., Shelygin Yu.A., Titov A.Yu. Treatment of fistula in ano by advancement flap. Is it outdated or still modern approach? Koloproktologia. 2016;(1):6–15. (In Russ.). DOI: 10.33878/2073-7556-2016-0-1-6-15
10. Kontovounisios C, Tekkis P, Tan E, et al. Adoption and success rates of perineal procedures for fistula-in-ano: a systematic review. Colorectal Dis. 2016;18(5):441–458. DOI: 10.1111/codi.13330
11. van der Hagen SJ, Baeten CG, Soeters PB, van Gemert WG. Autologous platelet-derived growth factors (platelet-rich plasma) as an adjunct to mucosal advancement flap in high cryptoglandular perianal fistulae: a pilot study. Colorectal Dis. 2011;13(2):215–218. DOI: 10.1111/j.1463-1318.2009.01991.x
12. Garg P, Singh P. Video-Assisted Anal Fistula Treatment (VAAFT) in Cryptoglandular fistula-in-ano: A systematic review and proportional meta-analysis. Int J Surg. 2017;46:85–91. DOI: 10.1016/j.ijsu.2017.08.582
13. O’Riordan JM, Datta I, Johnston C, Baxter NN. A systematic review of the anal fistula plug for patients with Crohn’s and non- Crohn’s related fistula-in-ano. Dis Colon Rectum. 2012;55(3):351–358. DOI: 10.1097/DCR.0b013e318239d1e4
14. Hong KD, Kang S, Kalaskar S, Wexner SD. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol. 2014;18(8):685–691. DOI: 10.1007/s10151-014-1183-3/
15. Sirany AM, Nygaard RM, Morken JJ. The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results. Dis Colon Rectum. 2015;58(6):604–612. DOI: 10.1097/DCR.0000000000000374
16. Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaC laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol. 2017;21:269–76.
17. Terzi MC, Agalar C, Habip S, Canda AE, et al. Closing Perianal Fistulas Using a Laser: Long-Term Results in 103 Patients. Dis Colon Rectum. 2018;61(5):599–603. Epub 2018/03/13. DOI: 10.1097/DCR.0000000000001038. Pub Med PMID: 29528908
18. Altomare DF. Anal fistula closure with FiLaC: new hope or the same old story? Tech Coloproctol. 2015;19(8):441–2. Epub 2015/07/19. DOI: 10.1007/s10151-015-1347-9. Pub Med PMID: 26187539.
19. Elfeki H, Shalaby M, Emile SH. et al. A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol. 2020;24(4):265–274. DOI: 10.1007/s10151-020-02165-1
20. Lauretta A, Falco N, Stocco E. et al. Anal Fistula Laser Closure: the length of fistula is the Achilles’ heel. Tech Coloproctol. 2018;22(12):933–939. DOI: 10.1007/s10151-018-1885-z
21. Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol. 2011;15:445–9.
22. Ozturk E, Gulcu B. Laser ablation of fistula tract: a sphincter- preserving method for treating fistula-in-ano. Dis Colon Rectum. 2014;57(3):360–4. Epub 2014/02/11. DOI: 10.1097/DCR.0000000000000067. PubMed PMID: 24509460.
23. Rosen DR, Kaiser AM. Definitive seton management for transsphincteric fistula-in-ano: harm or charm? Colorectal Dis. 2016;18:488–495.
24. van Onkelen RS, Mitalas LE, Gosselink MP. et al. Assessment of microbiota and peptidoglycan in perianal fistulas. Diagn Microbiol Infect Dis. 2013;75(1):50–54. DOI: 10.1016/j.diagmicrobio.2012.09.012
25. Laman JD, Schoneveld AH, Moll FL. et al. Significance of peptidoglycan, a proinflammatory bacterial antigen in atherosclerotic arteries and its association with vulnerable plaques. Am J Cardiol. 90:119–123.
26. de San Ildefonso Pereira A, Maruri Chimeno I, Facal Alvarez C. et al. Bacteriology of anal fistulae. Rev
27. Esp Enferm Dig. 2002;94(9):533–536.
Review
For citations:
Vasiliev S.V., Nedozimovanyi A.I., Popov D.E., Gor I.V., Moshkova T.A. Laser coagulation in combination with LIFT for transsphincteric anal fistulas. Koloproktologia. 2021;20(2):35-41. https://doi.org/10.33878/2073-7556-2021-20-2-35-41
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