Laser Therapy: A Breakthrough for Treating Complex High Intersphincteric Fistulas

Abstract Introduction: High Intersphincteric Tracts can be present in high complex, intersphincteric or complex transsphincteric fistulas. The tracts usually seen traversing up the intersphincteric plane while performing the Trans anal opening of intersphincteric plane, they can end blind or rectal perforation can be traced up. Treating these very thin tracts is challenging and if untreated, can cause of recurrence of fistula. Methods: Retrospective analysis of 12 patients with high complex fistula treated with trans anal opening of intersphincteric space approach and Diode 1470 Laser. Results: Out of 12 patient’s majority were male presented with Trans sphincteric fistula, anterior type of fistula. VAS scale readings for pain showed progressive improvement postoperatively during follow up. The difference between pre-operative VAS score and at the end of 2weeks,1 month & 3 months follow up was found statistically significant. Anal sphincter pressure (both ARD & AMD) showed statistically significant difference in preoperative and postoperative readings at 1 month, 3 month & 6 months follow up period. Conclusions: The intersphincteric component is present in most high complex fistulas and drainage of the intersphincteric space with identification and treatment of superior extensions of tracts in the Intersphincteric plane is crucial to prevent recurrence. Diode 1470 Laser is a new novel tool to treat higher extensions of IS tracts, the tracts can be curettaged using the round tip fistula fibre, which comes in 2 diameters, for use as per the diameter of the tracts. The very thin intersphincteric superior extensions can be finely cored and dissected up using the bare fibre which gives a very neat dissection. To conclude, Laser enables fine meticulous dissection or ablation, of the higher IS tracts in a minimal invasive way, thus minimising recurrences & damage to anal sphincter complex, as well as early postoperative recovery in high complex anal fistulas.