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Closing Perianal Fistulas Using a Laser: Long-Term Results in 103 Patients

Terzi, Mustafa, Cem, M.D.1; Agalar, Cihan, M.D.1; Habip, Sari, M.D.2; Canda, Aras, Emre, M.D.1; Arslan, Naciye, Cigdem, M.D.3; Obuz, Funda, M.D.4

Diseases of the Colon & Rectum: May 2018 - Volume 61 - Issue 5 - p 599–603
doi: 10.1097/DCR.0000000000001038
Original Contributions: Benign
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BACKGROUND: Primary closure of the fistula tract using energy emitted by a radial fiber connected to a diode laser is a novel procedure for treating perianal fistulas.

OBJECTIVE: The aim of this study was to determine the long-term effectiveness of this new technique.

DESIGN: The surgical objective was to seal the fistula tract using laser energy.

SETTINGS: The study was conducted at a single day-case surgery center.

PATIENTS: Between April 2012 and June 2016, 103 consecutive patients with primary or recurrent perianal fistula underwent a laser closure procedure using a 12-watt laser emitting at a wavelength of 1470 nm.

MAIN OUTCOME MEASURES: Patients were classified according to the Park classification, and healing was evaluated based on the perianal fistula disease severity score.

RESULTS: Among the 103 patients treated using the laser closure procedure, 82 (80%) were men and 21 (20%) were women. The median age of the patients was 43 years (range, 18–78 y). Fifty-three patients (52%) had previous perianal fistula repair surgery. Based on the Park classification, 56 patients (54%) had intersphincteric fistula, 29 (28%) had transsphincteric fistula, 11 (11%) had suprasphincteric or extrasphincteric fistula, and 7 (7%) had superficial perianal fistula. Based on the perianal disease severity score, 41 patients (40%) obtained overall complete healing, 38 (37%) had persistent symptomatic drainage, 20 (19%) had slight drainage with minimal symptoms, and 4 (4%) had painful symptomatic drainage.

LIMITATIONS: This was a retrospective analysis of noncomparative data with a lack of formal prospective continence assessment.

CONCLUSIONS: Closure of perianal fistulas using a laser should be considered as a treatment option but with modest expectations. Although our complete healing rate was not as high as in earlier studies, this technique is a reasonable option with nearly no risk of sphincter damage when treating perianal fistulas. See Video Abstract at

1 Department of General Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey

2 Department of General Surgery, Hekimhan State Hospital, Malatya, Turkey

3 Department of General Surgery, Istinye University School of Medicine, Istanbul, Turkey

4 Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey

Funding/Support: None reported.

Financial Disclosure: None reported.

Poster presentation at the annual meeting of the European Society of Coloproctology, Dublin, Ireland, September 22 to 25, 2015.

Correspondence: Cihan Agalar, M.D., Department of General Surgery, Dokuz Eylul University School of Medicine, Balcova Inciralti/Izmir 35340, Turkey. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons