Long-term outcomes of laser therapy for perianal fistulising Crohn’s disease: a single-center retrospective cohort study

Background: Perianal fistulizing Crohn’s disease (PFCD) remains therapeutically challenging, with high recurrence rates despite combined medical and surgical management. Laser ablation of the fistula tract has emerged as a sphincter-preserving option; however, long-term data in PFCD are limited. This study evaluated long-term outcomes of laser therapy in patients with PFCD.Methods: This retrospective single-center cohort included consecutive patients with PFCD who underwent laser ablation between January 2015 and December 2020. Clinical healing was defined as complete closure of the external opening without drainage for at least 3 months. Recurrence was defined as reappearance of drainage or fistula at the same site during follow-up. Outcomes included healing, recurrence, complications, and continence status.Results: Eleven patients were included. The median age was 31 years, and the median duration of Crohn’s disease was 9 years. Prior seton placement was performed in 81.8% of patients. The median follow-up was 62 months (range, 26–106). Sustained primary healing was achieved in 63.6% of patients, while 36.4% experienced recurrence. Early postoperative complications occurred in 36.4%, and no late abscess was observed. No long-term incontinence was reported.Conclusions: In this small cohort with extended follow-up, laser ablation achieved sustained healing in approximately two-thirds of patients with PFCD while preserving continence. Although limited by sample size and retrospective design, these findings support laser therapy as a feasible sphincter-preserving option within multidisciplinary management.