FiLaCTM, Minimal İnvazif Tedavi Seçeneği Olarak Anal Fistülde Başlangıç Tedavisinde İdeal Tercih mi?

Öz

Amaç: Lazer yöntemi (FiLaCTM), son zamanlarda anal fistül tedavisinde minimal invazif tedavi seçeneği olarak karşımıza çıkmaktadır. Anal fistül cerrahisi sonrası anal inkontinans ve fistül nüksü tedaviyi zorlaştıran postoperatif sorunlar olarak karşımıza çıkar. Çalışmamızda FiLaCTM yönteminin anal fistül tedavisinde etkinliğini ve tedavide hangi durumlarda tercih edilmesi ger-ektiğini araştırmayı amaçladık.
Materyal ve Metod: Temmuz 2017 ile Ağustos 2018 yılları arasında Derik Devlet Hastanesi’nde FiLaCTM diyot lazer uygulanan 12 hasta çalışmaya dâhil edildi. Hastalar retrospektif olarak, yaş, cinsiyet, inkontinans gelişimi, iyileşme ve işe dönüş zamanı, fistül tipleri, MR bulguları ve kom-plikasyonlar açısından analiz edildi.
Bulgular: Çalışmaya alınan hastaların 11’ü erkek 1 kadın olup yaş ortalaması 46 idi. İntraoperatif komplikasyon hiçbir hastada görülmedi. Ortalama takip süresi 13,5 (7-19) ay idi. Hastaların tak-iplerinde 4 (%33,3) hastada tam iyileşme gözlenirken, 8 (%66,7) hastada ise iyleşme sağlanamadı.
Sonuç: Anal fistül tedavisi için FiLaCTM prosedürü, güvenli, minimal invaziv, sfinkter koruyucu bir tedavi seçeneği olup düşük etkinliğe sahiptir. Ancak yüksek seviyeli fistüllerde, minimal invazif girişim isteyen hastalarda başlangıç tedavisi olarak tercih edilebilir.

Anahtar Kelimeler

• FiLaCTM
• anal fistül
• nüks

Is FiLaCTM the Ideal Choice for Initial Treatment of Anal Fistula as a Minimally Invasive Treatment Option?

Öz

Aim: The laser method (FiLaCTM) has recently emerged as a minimally invasive treatment option in the treatment of anal fistula. Anal incontinence and fistula recurrence after anal fistula surgery are postoperative problems that complicate the treatment. In our study, we aimed to investigate the effectiveness of the film method in the treatment of anal fistula and in which cases it should be preferred in the treatment. Methods: Twelve patients who underwent FiLaCTM diode laser at Derik State Hospital between July 2017 and August 2018 were included in the study. Patients were analyzed retrospectively in terms of age, gender, development of incontinence, recovery and return to work, fistula types, MRI findings, and complications. Results: 11 of the patients included in the study were male and 1 female and the mean age was 46. Intraoperative complications were not observed in any of the patients. The mean follow-up period was 13.5 (7-19) months. Complete recovery was observed in 4 (33.3%) patients in the follow-ups of the patients, while no improvement was achieved in 8 (66.7%) patients. Conclusion: The FiLaCTM procedure for the treatment of anal fistula is a safe, minimally invasive, sphincter-sparing treatment option with low efficacy. However, it can be preferred as an initial treatment in high-level fistulas and in patients who want minimally invasive intervention.

Anahtar Kelimeler

• FiLaCTM
• anal fistula
• recurrence

Kaynakça

1. 1. Nelson R. Anorectal abscess fistula: what do we know? Surgical Clinics. 2002; 82(6):1139-51.
2. 2. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. British Journal of Surgery. 1976; 63(1):1-12.
3. 3. Zeren S, Sobutay E, Ağca B, Durmuş A, Sarı K. A retrospective study of our surgical treatment experience in perianal fistulas. Okmeydanı Journal of Medicine. 2011; 27(2):76-8.
4. 4. Hall JF, Bordeianou L, Hyman N, Read T, Bartus C, Schoetz D et al. Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 2014; 57(11):1304-08.
5. 5. Abramowitz L, Soudan D, Souffran M, Bouchard D, Castinel A, Suduca JM et al, for the Groupe de Recherche en Proctologie de la Société Nationale Française de Colo- Proctologie and the Club de Réflexion des Cabinets et Groupe d’Hépato- Gastroentérologie. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study. Colorectal Dis. 2016; 18(3):279-85.
6. 6. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum. 1996; 39(7):723-29.
7. 7. Jordán J, Roig JV, García-Armengol J, García-Granero E, Solana A, Lledó S. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis. 2010; 12(3):254-60.
8. 8. Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RK. For many high anal fistulas, lay open is still a good option. Tech Coloproctol. 2011; 15(2):143-50.

9. 9. Adegbola SO, Sahnan K, Pellino G, Tozer PJ, Hart A, Phillips RKS et al. Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol. 2017; 21(10):775-82.
10. 10. Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol. 2011; 15(4):445-49.
11. 11. Wałęga P, Romaniszyn M, Nowak W. VAAFT: a new minimally invasive method in the diagnostics and treatment of anal fistulas--initial results. Pol Przegl Chir. 2014; 86(1):7-10.
12. 12. Grolich T, Skricka T, Robek O, Kala Z, Hemmelova B, Hrivnak R. Role of video assisted anal fistula treatment in our management of fistula-in-ano. Acta Chir Iugosl. 2014; 61(2):83-5.
13. 13. Seow-En I, Seow-Choen F, Koh PK. An experience with video-assisted anal fistula treatment (VAAFT) with new insights into the treatment of anal fistulae. Tech Coloproctol. 2016; 20(6):389-93.
14. 14. Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM. Seton treatment of high anal fistulae. Br J Surg. 1991; 78(10):1159-61.
15. 15. Vial M, Parés D, Pera M, Grande L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis. 2010; 12(3):172-78.
16. 16. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007; 90(3):581-86.
17. 17. Malakorn S, Sammour T, Khomvilai S, Chowchankit I, Gunarasa S, Kanjanasilp P et al. Ligation of Intersphincteric Fistula Tract for Fistula in Ano: Lessons Learned From a Decade of Experience. Dis Colon Rectum. 2017; 60(10):1065-70.
18. 18. Xu Y, Tang W. Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months. Biomed Res Int. 2017; 2017:3152424.
19. 19. Hjortrup A, Moesgaard F, Kjaergard J. Fibrin adhesive in the treatment of perineal fistulas. Dis Colon Rectum. 1991; 34(9):752-54.
20. 20. Malouf AJ, Buchanan GN, Carapeti EA, Rao S, Guy RJ, Westcott E et al. A prospective audit of fistula-in-ano at St. Mark’s hospital. Colorectal Dis. 2002; 4(1):13-9.
21. 21. Lara FJ, Serrano AM, Moreno JU, Carmona JH, Marquez MF, Pérez LR et al. Platelet-rich fibrin sealant as a treatment for complex perianal fistulas: a multicentre study. J Gastrointest Surg. 2015; 19(2):360-68.
22. 22. Ellis CN, Rostas JW, Greiner FG. Long-term outcomes with the use of bioprosthetic plugs for the management of complex anal fistulas. Dis Colon Rectum. 2010; 53(5):798-802.
23. 23. Gustafsson UM, Graf W. Randomized clinical trial of local gentamicin-collagen treatment in advancement flap repair for anal fistula. Br J Surg. 2006; 93(10):1202-07.
24. 24. Van Onkelen RS, Gosselink MP, Thijsse S, Schouten WR. Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas. Dis Colon Rectum. 2014; 57(8):1007-11.
25. 25. Giamundo P, Geraci M, Tibaldi L, Valente M. Closure of fistula-in-ano with laser–FiLaC™: an effective novel sphincter saving procedure for complex disease. Colorectal Dis. 2014; 16(2):110-15.
26. 26. Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F. Closing Perianal Fistulas Using a Laser. Diseases of the Colon & Rectum. 2018; 61(5):599–603.
27. 27. Marref I, Spindler L, Aubert M, Lemarchand N, Fathallah N, Pommaret E et al. The optimal indication for FiLaC® is high trans-sphincteric fistula-in-ano: A prospective cohort of 69 consecutive patients. Tech Coloproctol. 2019; 23(9):893–97.
28. 28. Nordholm-Carstensen A, Perregaard H, Hagen KB, Krarup PM. Fistula Laser Closure (FiLaC™) for fistula-in-ano—yet another technique with 50% healing rates? Int J Colorectal Dis. 2021; 36(9):1831-37.