Techniques in Coloproctology

, Volume 22, Issue 12, pp 933–939 | Cite as

Anal Fistula Laser Closure: the length of fistula is the Achilles’ heel

  • A. LaurettaEmail author
  • N. Falco
  • E. Stocco
  • R. Bellomo
  • A. Infantino
Original Article



Laser closure is a novel sphincter-saving technique for the treatment of anal fistula. The aim of this study was to report middle term results of laser treatment without closure of the internal orifice and to identify prognostic factors to improve selection criteria and maximize healing.


A retrospective observational study was conducted on patients treated with laser for transphinteric anal fistula. A diode laser emitting laser energy of 12W at a wavelength of 1470 nm was used. The relationship between fistula healing and age, sex, previous fistula surgery, location of fistula, and length of fistula tract was investigated. A successful outcome was defined by the complete healing of the surgical wound and external opening for at least 6 months.


Thirty patients (16 males, median age 52 years, range 26–72 years) underwent laser fistula closure between January 2015 and December 2016. Cure was achieved in 10 patients (33.3%). The mean follow-up was 11.30 months (range 6–24 months). Patients with persistent or recurrent fistula were offered repeat surgery. Eventually 4 underwent laser treatment once more. Two patients were cured leading to an overall healing rate of 40% (12 out of 30). Only 4 minor complications occurred (13.3%). No worsening of anal continence was registered. Only fistula length had a statistically significant correlation with successful treatment. Fistula tracts shorter than 30 mm were associated with a primary healing rate of 58.3% while tracts longer than 30 mm were cured in only 16.6% of cases (p < 0.02).


Laser closure is a safe and effective treatment for transphinteric anal fistula. The fistula length is the only significant prognostic factor when closing anal fistulas exclusively with laser: shorter fistulas have a better outcome.


Anal fistula Sphincter-saving technique Laser Prognostic factors 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the declaration of Helsinki of 1975, as revised in 2000 and 2008.

Informed consent

Informed consent was obtained from all participants included in the study.


  1. 1.
    Seow-Choen F, Nicholls RJ (1992) Anal fistula. Br J Surg 79:197–205CrossRefGoogle Scholar
  2. 2.
    Westerterp M, Volkers NA, Poolman RW, van Tets WF (2003) Anal fistulotomy between Skylla and Charybdis. Colorectal Dis 5(6):549–551CrossRefGoogle Scholar
  3. 3.
    Ellis CN (2010) Sphincter-preserving fistula management: what patients want. Dis Colon Rectum 53:1652–1655CrossRefGoogle Scholar
  4. 4.
    Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD (2011) Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 54(12):1465–1474CrossRefGoogle Scholar
  5. 5.
    Blumetti J, Abcarian A, Quinteros F, Chaudhry V, Prasad L, Abcarian H (2012) Evolution of treatment of fistula in ano. World J Surg 36(5):1162–1167CrossRefGoogle Scholar
  6. 6.
    Adegbola SO, Sahnan K, Pellino G, Tozer PJ, Hart A, Phillips RKS, Warusavitarne J, Faiz OD (2017) Short-term efficacy and safety of three novel sphincter–sparing techniques for anal fistulae: a systematic review. Tech Coloproctol 21:775–782. CrossRefPubMedGoogle Scholar
  7. 7.
    Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K (2007) Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai 90(3):581–586PubMedGoogle Scholar
  8. 8.
    Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15(4):417–422CrossRefGoogle Scholar
  9. 9.
    Chowbey PK, Khullar R, Sharma A, Soni V, Najma K, Baijal M (2015) Minimally invasive anal fistula treatment (MAFT)—an appraisal of early results in 416 patients. Indian J Surg 77(Suppl 2):S716–S721CrossRefGoogle Scholar
  10. 10.
    Prosst RL, Herold A, Joos AK, Bussen D, Wehrmann M, Gottwald T, Schurr MO (2012) The anal fistula claw: the OTSC clip for anal fistula closure. Colorectal Dis 14(9):1112–1117CrossRefGoogle Scholar
  11. 11.
    Garg P (2016) PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure. World J Gastrointest Surg 27(4):326–334 8(CrossRefGoogle Scholar
  12. 12.
    Cirocchi R, Trastulli S, Morelli U, Desiderio J, Boselli C, Parisi A, Noya G (2013) The treatment of anal fistulas with biologically derived products: is innovation better than conventional surgical treatment? An update. Tech Coloproctol 17(3):259–273CrossRefGoogle Scholar
  13. 13.
    Choi S, Ryoo SB, Park KJ, Kim DS, Song KH, Kim KH, Chung SS, Shin EJ, Cho YB, Oh ST, Kang WK, Kim MH (2017) Autologous adipose tissue-derived stem cells for the treatment of complex perianal fistulas not associated with Crohn’s disease: a phase II clinical trial for safety and efficacy. Tech Coloproctol 21(5):345–353. (Epub 31 May 2017) CrossRefPubMedGoogle Scholar
  14. 14.
    Wilhelm A (2011) A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol 15:445–449CrossRefGoogle Scholar
  15. 15.
    Giamundo P, Geraci M, Tibaldi L, Valente M (2013) Closure of fistula-in-ano with laser—FiLaC™: an effective novel sphincter saving procedure for complex disease. Colorectal Dis 16:110–115CrossRefGoogle Scholar
  16. 16.
    Giamundo P, Esercizio L, Geraci M, Valente M (2015) Fistula-tract laser closure (FiLaC™): long-term results and new operative strategies. Tech Coloproctol 19:449–453CrossRefGoogle Scholar
  17. 17.
    Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefGoogle Scholar
  18. 18.
    Tobisch A, Stelzner S, Hellmich G, Jackisch T, Witzigmann H (2012) Total fistulectomy with simple closure of the internal opening in the management of complex cryptoglandular fistulas: long-term results and functional outcome. Dis Colon Rectum Jul;55(7):750–755CrossRefGoogle Scholar
  19. 19.
    Limura E, Giordano P (2015) Modern management of anal fistula. World J Gastroenterol 21(1):12–20CrossRefGoogle Scholar
  20. 20.
    Rizzo JA, Naig AL, Johnson EK (2010) Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin N Am 90:45–68CrossRefGoogle Scholar
  21. 21.
    Swinscoe MT, Ventakasubramaniam AK, Jayne DG (2005) Fibrin glue for fistula-in-ano: the evidence reviewed. Tech Coloproctol 9(2):89–94CrossRefGoogle Scholar
  22. 22.
    O’Riordan JM, Datta I, Johnston C, Baxter NN (2012) A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum 55(3):351–358CrossRefGoogle Scholar
  23. 23.
    van Koperen PJ, Bemelman WA, Gerhards MF, Janssen LW, van Tets WF, van Dalsen AD, Slors JF (2011) The anal fistula plug treatment compared with the mucosal advancement flap for cryptoglandular high transsphincteric perianal fistula: a double-blinded multicenter randomized trial. Dis Colon Rectum 54(4):387–393CrossRefGoogle Scholar
  24. 24.
    Doganci S, Demirkilic U (2010) Comparison of 980 nm and bare tip fibre with 140 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised trial. Eur J Vasc Endovasc Surg 40:254.259CrossRefGoogle Scholar
  25. 25.
    Wilhelm A, Fiebig A, Krawczak M (2017) Five years of experience with the FiLaC™ laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol 21(4):269–276CrossRefGoogle Scholar
  26. 26.
    Memon AA, Murtaza G, Azami R, Zafar H, Chawla T, Laghari AA (2011) Treatment of complex fistula in ano with cable-tie seton: a prospective case series. ISRN Surg 2011:636952CrossRefGoogle Scholar
  27. 27.
    Lim CH, Shin HKS, Kang WH et al (2012) The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesses. J Korean Soc Coloproctol 28:309–314CrossRefGoogle Scholar
  28. 28.
    Kelly ME, Heneghan HM, McDermott FD, Nason GJ, Freeman C, Martin ST, Winter DC (2014) The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol 18:915–919CrossRefGoogle Scholar
  29. 29.
    Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RKS (2011) For many high anal fistulas, lay open is still a good option. Tech Coloproctol 15:143–150CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • A. Lauretta
    • 1
    Email author
  • N. Falco
    • 2
  • E. Stocco
    • 3
  • R. Bellomo
    • 3
  • A. Infantino
    • 3
  1. 1.Chirurgia Oncologica GeneraleCentro di Riferimento Oncologico di Aviano (CRO), IRCCSAvianoItaly
  2. 2.Department of SurgeryAAS-5 Friuli Venezia Giulia (affiliation with University of Palermo)San Vito al TagliamentoItaly
  3. 3.Department of SurgeryASS-5 Friuli Venezia GiuliaSan Vito al TagliamentoItaly

Personalised recommendations