Department of Surgery, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura, Egypt.
Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
Tech Coloproctol. 2020 Apr;24(4):265-274. doi: 10.1007/s10151-020-02165-1. Epub 2020 Feb 17.
Fistula laser closure (FiLaC) is a novel sphincter-saving technique for the treatment of fistula-in-ano. The aim of this study was to assess the safety and efficacy of the FiLaC procedure.
Databases including PubMed/Medline, Scopus, Web of Science, and Embase were searched for articles assessing FiLaC. All studies including case series and comparative studies reporting the outcome of FiLaC in the treatment of fistula-in-ano were considered eligible. The main outcomes were healing rates of fistula laser closure, postoperative complications including incontinence, technical aspects of the procedure and failure of healing.
Seven studies were included. There were a total of 454 patients, 69.1% with a transsphincteric fistula-in-ano and 35% with recurrent disease. The median age of the patients was 43 years (range 18-83 years). The median operation time was 18.3 min (range 6-32 min). With a median follow-up of 23.7 months, the weighed mean rate of primary healing was 67.3% and the overall success when FiLaC was reused was 69.7%. The weighted mean rate of complications was 4%, all of them were minor complications and the weighted mean rate of continence affection was 1% in the form of minor soiling.
FiLaC may be considered an effective and safe sphincter-saving technique for the treatment of fistula-in-ano with an acceptable, low, complication rate. However, well-designed randomized control trials comparing FiLaC with other techniques are required to substantiate the promising outcomes reported in this review.
瘘激光封闭（FiLaC）是一种治疗肛瘘的新型保肛技术。本研究旨在评估 FiLaC 手术的安全性和有效性。
检索包括 PubMed/Medline、Scopus、Web of Science 和 Embase 在内的数据库，评估 FiLaC 的文章。所有包括病例系列和比较研究的研究，报告 FiLaC 治疗肛瘘的结果均符合入选标准。主要结果是 FiLaC 闭合瘘的愈合率、术后并发症包括失禁、手术技术方面和愈合失败。
共纳入 7 项研究。共有 454 例患者，69.1%为经括约肌肛瘘，35%为复发性疾病。患者的中位年龄为 43 岁（范围 18-83 岁）。中位手术时间为 18.3 分钟（范围 6-32 分钟）。中位随访 23.7 个月，一期愈合的加权平均率为 67.3%，再次使用 FiLaC 的总成功率为 69.7%。并发症的加权平均发生率为 4%，均为轻微并发症，加权平均的控便功能影响率为 1%，表现为轻微污染。
FiLaC 可被认为是一种有效的、安全的保肛技术，用于治疗肛瘘，并发症发生率可接受且较低。然而，需要设计良好的随机对照试验来比较 FiLaC 与其他技术，以证实本综述中报告的有前景的结果。
