Core-Out Fistulectomy Combined With Laser Ablation of the Trans-Sphincteric Fistula Tract: A Pilot Study of Efficacy and Safety
Year: 2025
Type: article
Abstract: 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/Methods:This retrospective pilot study included 20 adult patients with magnetic resonance imaging (MRI)-confirmed trans-sphincteric fistulas (<6 mm diameter) treated between August and November 2024 at a tertiary referral center.Patients with inflammatory bowel disease, malignancy, or abscess were excluded.The fistula tract was surgically excised from the skin to the sphincter complex, and the trans-sphincteric portion was ablated using a 1470-nm diode laser.The primary outcome was fistula healing; secondary outcomes were healing time, complications, recurrence, and time to return to work. 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.
Source: Medical Science Monitor
DOI: 10.12659/msm.951819
Institution: İstanbul Eğitim ve Araştırma Hastanesi
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7117565054
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