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Rivista di Chirurgia
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2016 Ottobre;29(5):163-8
Laser surgery of anal fistulae
Giuliano QUARESIMINI, Gianni ROSSI
Department of General Surgery, Santo Stefano Hospital, Prato, Italy
BACKGROUND: The reason for this work is to report our personal experience encountered during track laser treatment on transsphincteric anal fistulas. The utilization of a 1470 nm frequency diode laser source — a fiber probe of 360° radial emission — determines the complete closure of the fistula. This experience as recounted hereby evidences very encouraging results obtained within absolute respect required for contiguous structures; specially so, the sphincteric musculature.
METHODS: During the period between June 2012 and June 2015, laser treatment was administered to 82 patients with the application of this procedure on complete trans-sphincteric, anal fistulas. Eighty-two percent of these said cases revealed the pathology of a first-time onset on the occasion, more than half of them had been provided with a seton placement to allow for drainage. The remaining patients revealed post-operative, fistula recurrences of conventional treatment; at times even three-to-four operations had already been performed on the same pathology. During the selection phase, however, patients with sub-mucous, inter-sphincteric fistulas were excluded and then subjected to an uncomplicated fistulotomy. No treatment had caused functional impairment to sphincter continence; nor were there incidences of intraoperative complications. All patients had been closely studied and subjected to colon proctologic examinations; to a perineal and trans-anal echography, in addition to an ulterior sphincteral MNM with ascertained or suspect cases of incontinence. These said cases were periodically under observation during the sphere of ensuing follow ups.
RESULTS: Sixty-eight patients out of 82 (83%) obtained complete closure; 7 turned out to be failures, manifesting fistula relapses within 15 days of treatment. One valid result, nevertheless conditioned by significantly painful symptomatology. Two cases presented partial results: (closure of one of the two tracks of a complex fistula; partial peripheral fistulotomy with an excellent result on the deep track). Four cases presented post-operative abscess-causation was treated by instituting antibiotic therapy, in addition to compresses, that resulted in a resolution devoid of recurrences. The average duration of operation took 18 minutes (range 9-32) and no operative complications were encountered.
CONCLUSIONS: It appears evident that track laser treatment is significantly well tolerated and safe. Its execution is relatively straightforward, repeatable and devoid of sphincteric musculature complications. There existed an attitude of outstanding compliance of the part of patients. Postoperatively, pain symptomology was negligible and patients’ routine activities could readily be undertaken.