Role of Laser Ablation of Fistula Tract in High Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Aim of the Work To assess and evaluate the efficacy and safety of LASER ablation of high perianal fistula. Patients and Methods This study is a randomized prospective study which will be conducted at Ain Shams University hospitals recruiting (20) patients and will be operated upon between January 2021 and July 2021 with minimal follow up to 3 months postoperatively. Results From these studies, it emerges that this procedure has some advantages. It doesn’t affect continence, administers controlled hyperthermic effect to the tissues, has a short learning-curve and reduces postoperative hospital stay as compared to endorectal advancement flap or LIFT. However, it has also some drawbacks. It is a blind procedure, as it’s not possible a direct visualization of the fistula tract or any secondary tracts and this may lead to recurrence. It requires expensive equipment, particularly if compared to other sphincter-saving techniques. Conclusion LASER ablation is a technique that has a promising results regarding complex perianal fistula preserving anal continence and short healing period and low recurrence rate as regarding classic and other techniques.