Comparative study between surgical outcomes of: fistula tract LASER closure (FiLaCTM) versus fistulotomy with primary sphincter reconstruction in management of high trans-sphincteric perianal fistula

Abstract

The aim of the study: to compare between fistula tract LASER closure FiLaCTM versus fistulotomy with primary sphincter reconstruction in management of high trans-sphincteric perianal fistula regarding surgical outcomes within short term follow up period of 6 months. Methods: The present study was a comparative prospective study including 40 patients with high trans-sphincteric (non-branching) fistula from outpatient clinic at Ain-Shams University. Study period was 9 months, including 6 months duration for follow up, study began on 1st April 2021. Results: six months of follow-up showed statistically high substantial variations between groups regarding visual analog scale (VAS) score (especially during early post operative period) with high score in group (B) (fistulotomy and 1ry sphinctroplasy) when comparing with group (A) (FiLaC) (P>0.001). At 1 month there were no statistically significant differences between groups according to healing, Wexner score and VAS score. While at 3 months we found statistically significant differences between groups as regard to VAS score with high score in group (B) when comparing with group (A) where P<0.001 [however, at 3 months of follow up the maximum VAS score of any patient in both groups was (1)], while Wexner score and recurrence rate didn’t show any statistically significant differences between groups. At 6 months of follow there were no statistically significant differences between groups as regard recurrence rate and Wexner score. Long duration of fistula and Diabetes Miletus as a comorbidity was associated with delayed healing and increased fistula recurrence rate, this correlation was statistically expressed as follow: Diabetes Miletus (r= -0.404, P=0.010) and fistula duration (r= -0.640, P<0.001). Conclusion: Both fistula tract LASER closure (FiLaCTM) and sphincterotomy with primary sphincter reconstruction were safe and effective in the treatment of high trans-sphincteric perianal fistula. The fistula tract LASER closure was superior in terms of operative time, postoperative hospital stays, VAS Score and Wexner score but in terms of success rate the sphincterotomy with primary sphincter reconstruction had higher success rates and lower recurrences. We found that chronic disease and fistula duration were predictors of adverse outcome.