Year 2023 / Volume 115 / Number 12
Original
FiLaC® procedure for highly selected anal fistula patients: indications, safety and efficacy from an observational study at a tertiary referral center

700-706

DOI: 10.17235/reed.2023.9644/2023

Lara Blanco Terés, Elena Bermejo Marcos, Carlos Cerdán Santacruz, Alba Correa Bonito, Ana Rodríguez Sanchez, María Chaparro, Javier P. Gisbert, Javier García Septiem, Elena Martín-Pérez,

Abstract
Background: the ideal clinical profile of patients or fistula features for fistula laser closure (FiLaC®) technique remain to be established. The aim of this study was to analyze clinical outcomes and the safety profile of FiLaC® in search for an ideal setting for this technique. Methods: a retrospective observational study was performed from a prospective database including all consecutive patients who underwent surgery for anal fistula (AF) with FiLaC® in the coloproctology unit of a tertiary referral center, between October 2015 and December 2021. The FiLaC® procedure was offered to AF patients who were considered to be at risk of fecal incontinence. Fistulas were described according to Parks’ classification and categorized as complex or simple according to the American Gastroenterological Association (AGA) guidelines. Healing was defined by the closure of the internal and external openings for at least six months. Predictive factors of AF healing were investigated. Results: a total of 36 patients were included, with a mean age of 48 ± 13.9 years. Twenty patients (55.6 %) were male and 13 patients (36 %) had Crohn’s disease (CD). Fourteen patients (38.8 %) had a complex fistula. The primary and secondary healing rates were 55.6 % and 91.7 %, respectively, during a median follow-up time of 12 months (IQR 7-29). No fecal continence impairment was registered in any case. The proportion of patients with primary healing was significantly higher in CD patients (76.9 % vs 43.5 %, p = 0.048). Conclusions: FiLaC® is a sphincter-preserving procedure with an excellent safety profile and reasonable success rate despite of the strict patient selection. This technique may be attractive for patients with CD due to its higher primary healing rate.
Lay Summary
We analyze clinical outcomes and the safety profile of fistula laser closure (FiLaC®) in search for an ideal setting for this technique. Predictive factors of anal fistula healing were investigated from all patients operated with this procedure in our coloproctology unit between October 2015 and December 2021. FiLaC® was offered to patients with anatomically complex anal fistula and to patients with anatomically simple anal fistula who were considered to be at high risk of fecal incontinence. The presence of a wide internal opening indicating a wide tract, and the presence of perianal cavities or abscesses were considered as contraindications for this procedure. A total of 36 patients were included in this study. The primary and secondary healing rates were 55.6% and 91.7%, respectively, in a median follow-up time of 12 months. No fecal continence impairment was registered in any case. The proportion of patients with primary healing was significantly higher in Crohn disease patients (76.9% vs. 43.5%). As the result, FiLaC® has an excellent safety profile and reasonable success rate despite of strict patients’ selection. This technique may be attractive for patients with Crohn disease due to its higher primary healing rate.
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Blanco Terés L, Bermejo Marcos E, Cerdán Santacruz C, Correa Bonito A, Rodríguez Sanchez A, Chaparro M, et all. FiLaC® procedure for highly selected anal fistula patients: indications, safety and efficacy from an observational study at a tertiary referral center. 9644/2023


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Publication history

Received: 03/04/2023

Accepted: 29/06/2023

Online First: 14/07/2023

Published: 12/12/2023

Article revision time: 76 days

Article Online First time: 102 days

Article editing time: 253 days


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