Role of Lasers in Anal Fistula Repair

A BSTRACT An anal fistula is described as an external abnormal anatomical connection between the anorectal canal and the perianal skin. The incidence of anal fistulas is reported to be 5.6 and 12.3 per 100,000 in women and men, respectively. Anal fistulas are usually present as anorectal pain, perianal cellulitis, smelly or bloody drainage of pus, pruritus ani, and difficulty in controlling bowel movements. The treatment of anal fistulas is challenging. Eradication of the primary track is the main goal of treatment. The earliest attempts were made to treat these fistulas with a loop of nonabsorbable material passed through the fistula tract called a seton. Ligation of the intersphincteric fistulous tract technique was another such technique introduced for its treatment. Many sphincter-preserving procedures for the treatment of anal fistulas have been introduced in the last two decades. Wilhelm first described the use of laser for the treatment of anal fistulas in 2011. The radial-emitting laser probe (Fistula laser closure [FiLaC™], Biolitec, Germany) is a sphincter-saving technique that obliterates the remnant tract and destroys the fistula epithelium. A number of studies have been conducted to demonstrate the use of lasers with a success rate ranging between 22% and 89%. Here, we have provided a detailed review of the literature of studies conducted in the last couple of decades demonstrating the role of lasers for the repair of anal fistulas with the types of lasers used, success rates, and the probable reasons for the difference in the success rates between studies and recurrence rates.