Department of General and Visceral Surgery, Marien Hospital Witten, Teaching hospital of the Ruhr University Bochum, Marienplatz 2, 58452, Witten, Germany.
Tech Coloproctol. 2021 Feb;25(2):177-184. doi: 10.1007/s10151-020-02332-4. Epub 2020 Aug 31.
The treatment of anal fistula remains a challenge between maintaining continence and radical surgery to prevent recurrence. Fistula-tract Laser Closure (FiLaC) is a sphincter-saving technique using a radial emitting laser fibre to close the fistula tract. The aim of this study was to report long-term outcomes in patients who received FiLaC therapy for transsphincteric and intersphincteric anal fistula between January 2011 and December 2017.
A retrospective study was performed on patients who were treated with FiLaC- for a transsphincteric and intersphincteric anal fistula at our institution between January 2011 and December 2017. In all patients, the FiLaC procedure was combined with a closure of the internal orifice using a simple 3-0 Z stitch. Patient characteristics, previous proctological history, healing rates, failures and postoperative continence were investigated.
The study included 83 patients [mean age 50.01 ± 14.59 years. 64 (77.1%) males] with a mean follow-up period of 41.99 (± 21.59) months (range 4-87 months). Thirteen patients (15.7%) had a recurrent fistula. 65 patients (78.3%) had undergone prior abscess drainage with insertion of a seton. The primary healing rate was 74.7% (62 of 83 patients) overall. Eleven (13.3%) of the 21 patients (25.3%) who failed FiLaC-therapy underwent a second operation. In eight cases, Re-FiLaC and in three cases, fistulectomy with closure of the internal orifice was performed. Afterwards 6 (54.5%) of these 11 patients could be considered cured: 3 who had fistulectomy and three who had Re-FiLaC treatment. The overall healing rate after second FiLaC was 78.3% (65 of 83 patients) while the overall healing rate for FiLaC therapy combined with any second procedure was 81.9% (68 of 83 patients). The follow-up period in this group of 11 patients who received re-operation was 38 months (range 13-84 months). Changes in continence occurred in eight patients (9.6%). No patient reported major incontinence postoperatively.
The FiLaC procedure is associated with good healing rates in long-term follow-up and should be considered as a treatment option for transsphincteric and intersphincteric anal fistulae, especially due to the low complication rate and low risk of sphincter injury.
肛门瘘的治疗仍然是一个挑战，需要在保持肛门括约肌功能和根治性手术以预防复发之间取得平衡。瘘管激光闭合术（FiLaC）是一种保留括约肌的技术，使用放射状发射激光纤维来闭合瘘管。本研究的目的是报告 2011 年 1 月至 2017 年 12 月期间接受 FiLaC 治疗的经括约肌和括约肌间肛门瘘患者的长期结果。
对 2011 年 1 月至 2017 年 12 月期间在我院接受 FiLaC 治疗的经括约肌和括约肌间肛门瘘患者进行回顾性研究。在所有患者中，FiLaC 手术与使用简单的 3-0 Z 缝线闭合内口相结合。调查患者特征、既往肛肠病史、愈合率、失败和术后肛门括约肌功能。
研究共纳入 83 例患者[平均年龄 50.01 ± 14.59 岁。64 例（77.1%）为男性]，平均随访时间为 41.99（± 21.59）个月（4-87 个月）。13 例（15.7%）患者出现复发瘘管。65 例（78.3%）患者曾行脓肿引流术并置入挂线。总体一期愈合率为 74.7%（83 例患者中有 62 例）。21 例（25.3%）FiLaC 治疗失败的患者中有 11 例（13.3%）接受了二次手术。在 8 例患者中，进行了二次 FiLaC，在 3 例患者中，进行了瘘管切除术并闭合内口。之后，这 11 例患者中有 6 例（54.5%）被认为治愈：3 例接受瘘管切除术，3 例接受二次 FiLaC 治疗。第二次 FiLaC 后的总体愈合率为 78.3%（83 例患者中有 65 例），而 FiLaC 联合任何二次手术的总体愈合率为 81.9%（83 例患者中有 68 例）。这 11 例接受再次手术的患者的随访时间为 38 个月（13-84 个月）。8 例患者（9.6%）出现肛门括约肌功能改变。术后无患者报告严重的肛门失禁。
FiLaC 手术在长期随访中具有良好的愈合率，应被视为经括约肌和括约肌间肛门瘘的治疗选择，特别是因为其并发症发生率低，肛门括约肌损伤风险低。
