The optimal indication for FiLaC is high trans-sphincteric fistula-in-ano: a prospective cohort of 69 consecutive patients.

BACKGROUND

The aim of our study was to prospectively evaluate the effectiveness of the Fistula Laser Closure (FiLaC) technique in patients at high risk of anal incontinence and to determine the predictors of success and the impact of the procedure on anal continence.

METHODS

A prospective study was conducted on all patients treated with FiLaC in our department in May 2016-April 2017, because they were at high risk of anal incontinence after fistulotomy, The fistula was considered healed when the internal and external openings were closed and the patient experienced was no pain or leakage.

RESULTS

A total of 69 consecutive patients (34 males) with a median age of 40 years (33-53 years) were included in the study. One patient was lost to follow up. The fistulas were intersphincteric (3%), low (15%) or high (66%) trans-sphincteric, and suprasphincteric (16%). After a median follow-up period of 6.3 months (4.2-9.3), fistula healing was observed in 31 patients (45.6%). In univariate analysis, high trans-sphincteric fistulas (p = 0.007) and age over 50 years (p = 0.034) were significantly associated with healing. In multivariate analysis, only high trans-sphincteric fistulas were a predictive factor of significant success. No new cases of anal incontinence or any worsening in case of pre-existing anal incontinence were observed during follow-up.

CONCLUSIONS

FiLaC is particularly effective in cases of high trans-sphincteric fistulas (60% cure). This technique seems to be the most promising sphincter-saving technique available for this indication.