Chirurgia Oncologica Generale, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, 33081, Italy.
Department of Surgery, AAS-5 Friuli Venezia Giulia (affiliation with University of Palermo), San Vito al Tagliamento, 33078, Italy.
Tech Coloproctol. 2018 Dec;22(12):933-939. doi: 10.1007/s10151-018-1885-z. Epub 2018 Dec 8.
Laser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing.
A retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470 nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of fistula tract was investigated. A successful outcome was defined by the complete healing of the surgical wound and external opening for at least 6 months.
Thirty patients (16 males, median age 52 years, range 26-72 years) underwent laser fistula closure between January 2015 and December 2016. Cure was achieved in 10 patients (33.3%). The mean follow-up was 11.30 months (range 6-24 months). Patients with persistent or recurrent fistula were offered repeat surgery. Eventually 4 underwent laser treatment once more. Two patients were cured leading to an overall healing rate of 40% (12 out of 30). Only 4 minor complications occurred (13.3%). No worsening of anal continence was registered. Only fistula length had a statistically significant correlation with successful treatment. Fistula tracts shorter than 30 mm were associated with a primary healing rate of 58.3% while tracts longer than 30 mm were cured in only 16.6% of cases (p < 0.02).
Laser closure is a safe and effective treatment for transphinteric anal fistula. The fistula length is the only significant prognostic factor when closing anal fistulas exclusively with laser: shorter fistulas have a better outcome.
激光闭合术是一种治疗肛瘘的新型保肛技术。本研究旨在报告激光治疗无内口闭合的中期结果，并确定预测因素，以改善选择标准并最大限度地提高愈合率。
对 2015 年 1 月至 2016 年 12 月期间接受激光治疗的经肛旁肛瘘患者进行回顾性观察性研究。采用波长为 1470nm、激光能量为 12W 的二极管激光。研究瘘管愈合与年龄、性别、既往瘘管手术、瘘管位置和瘘管长度之间的关系。成功的结果定义为手术伤口完全愈合，且外口至少持续 6 个月。
30 例患者（男 16 例，中位年龄 52 岁，范围 26-72 岁）接受了激光瘘管闭合治疗。10 例（33.3%）患者治愈。平均随访时间为 11.30 个月（范围 6-24 个月）。对持续或复发的瘘管患者进行了再次手术。最终 4 例再次接受激光治疗，2 例治愈，总体愈合率为 40%（30 例中的 12 例）。仅发生 4 例轻微并发症（13.3%）。未发现肛门控便功能恶化。只有瘘管长度与治疗成功有统计学显著相关性。瘘管长度小于 30mm 的患者初次愈合率为 58.3%，而瘘管长度大于 30mm 的患者仅治愈 16.6%（p<0.02）。
激光闭合术是治疗经肛旁肛瘘的一种安全有效的方法。当仅用激光闭合肛瘘时，瘘管长度是唯一重要的预后因素：较短的瘘管有更好的结果。
