Treatment Modalities in Complex Anal Fistulas: Comparison of Conventional Hybrid Seton Techniques with the Laser Ablation

The treatment of complex anal fistulas continue to be debatable. This study aims to compare the outcomes of Hybrid Seton Technique (HST) with Laser Ablation of Fistula Tract (LAFT) treatment. A retrospective cohort study was conducted on patients who underwent surgery between January 2013 and October 2021 to compare the effectiveness of the conventional HST and LAFT in terms of recurrence rates, time to return to work, and factors influencing recovery. Anal continence was assessed using the Wexner score, both before and after the intervention. Sixty-four patients were included: 41 treated with HST and 23 with LAFT. Most fistulas were high transsphincteric (87.5%). Fistula length and diameter did not differ significantly between groups. Fistula healing time was significantly shorter in the LAFT group 12.00 (9.00–15.50) days than in the HST group 30.0 (25.0–50.0) days (p < 0.001). Similarly, return-to-work time favored LAFT (p < 0.001). Recurrence occurred in 7 HST patients (17.1%) and 3 LAFT patients (13.0%). In the LAFT group, primary healing occurred in 60.9% and increased to 86.9% following secondary interventions. Patients with recurrence exhibited significantly higher Wexner scores both preoperatively and at follow-up. LAFT offers a faster postoperative recovery with shorter healing and earlier return to work. However, despite its minimally invasive nature, LAFT required more secondary interventions, and the HST group demonstrated a higher final success rate. LAFT may be suitable for selected patients, whereas HST remains a more definitive option for complex high fistulas.