What is anal laser surgery?
Lasers are increasingly being used in a variety of surgical procedures as a less invasive option. One novel technique that can be used as an option to treat anal fistulas is the FiLaC™ (fistula laser closure) technique. This involves the use of a laser fiber to seal the fistula.
Why is it done?
The FiLaC technique is used to close anal fistulas, i.e., tunnels that can develop from the end of the bowel to the skin near the anus. Anal fistulas usually occur when an anal abscess is drained of pus, leaving an empty canal, although they can also be complications of Crohn’s disease, diverticulitis, diseases such as tuberculosis or HIV, or complications of surgery in that area.
Anal fistulas can cause pain and irritation and may leak a foul-smelling discharge. People suffering from this condition may find blood and pus in their stool and, in some cases, may have difficulty controlling their bowel movements.
This unpleasant condition can be treated with several surgical options, ranging from cutting the fistula open so that it heals like a scar (fistulotomy) to blocking it with a special glue or cone-shaped plug. Each procedure has its own advantages and disadvantages, and there is little consensus on which, if any, is the best option for the patient.
Anal fistulas can cause pain and irritation and can leak a foul-smelling discharge.
The advantage of using a laser is that it is less invasive and causes minimal damage to the sphincter muscle, reducing the risk of incontinence after the procedure. However, the risk of fistula recurrence is higher than in some of the other treatments.
What does it consist of?
Laser fistula closure involves inserting the laser fiber into the fistula from the outside and passing it through the opening into the rectum. The laser is then activated, causing the surrounding tissue to contract as the proteins are denatured. The laser is slowly drawn back through the fistula at a rate of about 1 cm every three seconds, sealing the channel behind it. The internal opening is closed with a suture and in some cases with a skin flap.
How to prepare for laser anal surgery?
Some preparation may be needed before the FiLaC procedure, including a rectal enema one day before the operation to prepare the bowel for surgery and to prepare the fistula itself. This may involve probing the fistula with a catheter, flushing it with saline, and performing a resection of the internal opening, putting the myomucosal flap in place.
Patients usually stay in the hospital for two to three days after the procedure while physicians monitor the healing process. As with other treatments, for anal fistulas, there is a possibility that the fistula laser closure may fail and the fistula may reopen, in which case the physician may recommend other options.
Alternatives to this treatment
Alternative treatments for anal fistulas may include:
- Fistulotomy: the most common and possibly the most effective treatment. However, if the fistula passes through the anal sphincter muscles, removing it with a fistulotomy may leave them damaged and leave the patient unable to control bowel movements.
- Seton techniques: using surgical thread to hold the fistula open to let it drain and stimulate it to heal on its own, without the need to cut the anal sphincter muscles.
- Breakthrough flap procedures: similar to FiLaC, but using traditional surgical tools to cut or scrape the fistula instead with a laser. A flap of tissue taken from the rectum is used to close the opening.
- Bioprosthetic plug: a cone-shaped plug made of animal tissue is used to block the internal opening of the fistula. NICE currently recommends this procedure as part of medical research, as more data on its effectiveness is needed.
- Fibrin glue: the only non-surgical option, this special glue helps seal and heal the fistula.