Core-Out Fistulectomy Combined With Laser Ablation of the Trans-Sphincteric Fistula Tract: A Pilot Study of Efficacy and Safety

BACKGROUND The primary goal of anal fistula treatment is eradication of the fistula while preserving continence and minimizing the risk of recurrence. Although fistulotomy is effective for simple fistulas, management of complex trans-sphincteric fistulas remains challenging. Sphincter-sparing techniques show variable outcomes, with high recurrence rates and risk of incontinence. This study evaluated a hybrid technique combining core-out fistulectomy with trans-sphincteric laser ablation to improve healing while preserving sphincter function. MATERIAL AND METHODS This retrospective pilot study included 20 adult patients with magnetic resonance imaging (MRI)-confirmed trans-sphincteric fistulas ( RESULTS Twenty patients (12 males; mean age 40.5 years) underwent the procedure. The overall healing rate was 90% (18/20). Mean healing time was 6.4 weeks, with a mean follow-up of 9.9 months. Two patients experienced recurrence. No significant postoperative complications or continence disturbances were observed. The mean time to return to work was 8.9 days, and all patients resumed normal daily activities the day after surgery. CONCLUSIONS Core-out fistulectomy combined with trans-sphincteric laser ablation appears to be a safe and effective treatment for selected trans-sphincteric fistulas. Larger prospective studies with longer follow-up are needed to confirm these findings.