To compare efficiency of treatment of anal fistula:noninvasive surgery method laft treatment and invasive surgycal treatments

Purpose: Fistula laser closure (LAFT) is a novel non-invasive procedure for the treatment of perianal fistula. Primary closure of the fistula tractus is obtained using laser energy emitted by a radial fiber connected to a diode laser. The aim of this study is to determine the effectiveness of this new technique in the treatment of anal fistula and compare with classic surgical treatment. Patients And Method: Between July 2010 and August 2013 97 consecutive patients with primary or recurrent perianal fistula underwent 52 patients classic surgical treatment and 45 patients LAFT procedure. The surgical procedure was sealing of the fistula tractus by laser energy and classic surgical treatments were fistulotomy and internal sphincterotomy added external sphincteric loose seton. 28 patients (29%) female, 69 patients (71%) were men. LAFT procedure group, mean age 42 (18-74) and the follow-up period was 3.5 months and 1.5 years (mean: 9.6 months). Patients who were operated with conventional methods mean age was 48 years (34-68 years) and follow-up time was 3.5 months -3 years (mean: 2 years). In determining the type of fistula surgery we used preoperative MR images and Park's classification . The types of the fistulas: Simple fistula in 8 patients, intersphincteric fistula in 44 patients, trassphincteric fistula in 40 patients , extrasphincteric fistula in 3 patients and suprasphincteric fistula in 2 patients . 45 patients (46%) higher in 52 (54%) had low type fistula.The primary outcome was cure of the disease. Results: No intraoperative complication was seen. Complete healing was observed in 36 patients(69.1%) and 16 recurrences (30.9%) was observed in classic surgical group. İn LAFT procedure group complete healing was observed in 16 patients (36%), 29 patients had recurrences (65%) were detected. 13 (29%) patients had slight drainage with minimal symptoms , 14 (31%) patients had persistent symptomatic drainage , 2 (4%) patients had painful symptomatic drainage . In classic surgical group Wexner score was: 2.03, Fecal İncontenence Quality of Life score was: 105.26 . LAFT procedure group the scores respectively 0.2 and 111.91. Return to work and recovery times compared in both groups. LAFT procedure group patients can return to work after one day and the average recovery time was 20.8 days. In classic surgical group patients can return to work after 6.5 days and the average recovery time was 38.4 days Conclusion: Perianal fistula surgery by invasive procedure causes higher rates of incontinence, lower quality of life. Because of this alternative treatments are trying to develop. This new approach for perianal fistula is a non-invasive, safe and simple procedure. Regarding half of the patients had recurrent fistulas, a cure rate of 36% was reasonable. Moreover we achieved significant symptomatic control in 2/3 of the patients. Also the low return to work and recovery time, low incontinence rates and higher quality of life scores in treatment of perianal fistulas FiLaCTM procedure is an alternative.Despite the relatively good results of our study, larger series and randomized trials are needed to have a final decision on the effectiveness of this procedure.