Comparison of the effectiveness of LAFT technique and hybrid seton in the treatment of high-located anal fistula

Yıl 2024, , 364 - 368, 30.09.2024

Eyüp Murat Yılmaz , Erkan Karacan

https://doi.org/10.18663/tjcl.1431618

Öz

Aim: Many surgical techniques have been described for the treatment of high-located anal fistulas, and each surgical technique has its own advantages. In our study, we aimed to compare the long-term results of the hybrid seton technique and the laser ablation technique of the fistula tract in the surgical treatment of high-located anal fistulas.
Material and Methods: Patients who underwent laser ablation therapy (LAFT) and hybrid seton due to high-located anal fistula between June 2020 and April 2023 would be included in the study, and patients with a postoperative follow-up period of less than 6 months would be excluded from the study. The patients' files were evaluated retrospectively and their postoperative complications, preoperative and postoperative 1st month Cleveland fecal incontinence scores (CCFFSI scores), postoperative first day and first week visual analog scale (VAS) scores, follow-up periods, and recurrence rates were evaluated. Patients with a follow-up period of less than 6 months and patients treated for anal fistula due to Crohn's disease were excluded from the study.
Results: A total of 74 patients were evaluated. 32 patients were operated with LAFT (group 1), and 42 patients were operated with hybrid seton technique (Group 2). Postoperative anal abscess developed in 2 patients in Group 1 and in one patient in Group 2. Follow-up periods were calculated as 48.43±9.99, 39.26±11.17 weeks, respectively, and postoperative first day VAS scores were calculated as 4.53±1.36, 4.61±0.93, respectively. Postoperative Day 7 VAS scores were calculated as 0.96±1.14, 1.83±0.98, respectively. Preoperative CCFI scores were calculated as 1.71±1.25, 2.19±0.7, respectively. Postoperative CCFI scores were calculated as 1.78±1.23, 3.76±1.26, respectively. Postoperative recurrence occurred in 9 patients in group 1 and in 4 patients in group 2.
Conclusion: Although laser ablation of the fistula tract is a method that does not affect incontinence and has high postoperative comfort, its high recurrence rate should be taken into consideration.

Anahtar Kelimeler

Hybrid seton, laser ablation of fistula tract, laser

Yüksek yerleşimli anal fistül tedavisinde LAFT tekniği ve hibrid setonun etkinliğinin karşılaştırılması

Öz

Amaç: Yüksek yerleşimli anal fistüllerin tedavisinde pek çok cerrahi teknik tanımlanmış her cerrahi tekniğin kendine ait avantajları vardır. Bizde çalışmamızda yüksek yerleşimli anal fistüllerin cerrahi tedavisinde hibrid seton tekniği ile fistül yolunun lazer ablasyonu tekniğinin uzun dönem sonuçlarını kıyaslamayı amaçladık.
Gereç ve Yöntemler: Haziran 2020- Nisan 2023 yılları arasındaki yüksek yerleşimli anal fistül nedeniyle lazer ablasyon tedavisi (LAFT) ve hibrid seton uygulanan hastalar çalışmaya dahil edilecek olup postoperatif takip süresi 6 aydan kısa olan hastalar çalışma dışı bırakılacaktır. Hastaların dosyaları retrospektif olarak değerlendirilerek hastaların postoperatif komplikasyonları, preop ve postop 1. ay Cleveland fekal inkontinans skorları(CCFFSI score), postop birinci gün birinci hafta visual analog scale (VAS) skorları, takip süreleri, nüks oranları değerlendirildi. Takip süreleri 6 aydan kısa olan hastalar, chrohn hastalığı nedeni ile anal fistül tedavisi uygulanan hastalar çalışma dışı bırakıldı.
Bulgular: Toplam 74 hasta değerlendirildi. 32 hasta LAFT (grup1), 42 hasta hibrid seton tekniği (Grup 2) ile opere edildi. Grup 1 de 2, Grup 2 de bir hastada postoperatif anal apse gelişti. Takip süreleri sırasıyla 48,43±9,99, 39,26±11,17 hafta; postoperatif birinci gün VAS skorları sırası ile 4,53±1,36, 4,61±0,93 olarak hesaplandı. Postop 7. Gün VAS skorları sırası ile 0,96±1,14, 1,83±0,98 olarak hesaplandı. Preop CCFI skorları sırası ile 1,71±1,25, 2,19±0,7 olarak hesaplandı. Postoperatif CCFI skorları sırası ile 1,78±1,23, 3,76±1,26 olarak hesaplandı. Postoperatif grup 1 de 9 grup 2 de 4 hastada nüks gelişti.
Sonuç: Fistül yolunun lazer ile ablasyonu inkontinansı etkilemeyen, postoperatif konforu yüksek bir yöntem olmasına rağmen nüks oranının yüksek olması göz önünde bulundurulmalıdır.

Anahtar Kelimeler

hibrid seton, fistül traktının lazer ablasyonu, lazer

Etik Beyan

Ethics committee approval of the study was obtained from a tertiary university hospital, and the Declaration of Helsinki designed the study. Informed Consent: All patients were informed about the procedure, and certificate of consent was taken for every patient.

Destekleyen Kurum

none

Kaynakça

• Iqbal N, Shah R, Alrubaiy L, et al. Do Patient-Reported Quality-of-Life (QoL) Scales Provide an Adequate Assessment of Patients with Cryptoglandular Anal Fistulae? A Systematic Review of Measurement Instruments and Their Content Validity. Clin Pract, 2022;15:12(4):628-639.
• Garg P. Management of fistula-in-ano: an evidence-based review. Techniques in Coloproctology. 2016;20(8), 517-525.
• Karacan E, Yılmaz EM. Treatment of the fistula tract with laser ablation in high anal fistula. Journal of Clinical Medicine of Kazakhstan, 2022;19(6): 43-45.
• Gulen M, Sariyildiz GT, Pala MI, et al.The effect of hybrid seton on anal continence and quality of life in transsphincteric fistulas. Ann. Ital. Chir, 2022;93(6): 716-719.
• Araújo SEA, Marcante MT, Mendes CRS, et al. Interesfincterial ligation of fistula tract (lift) for patients with anal fistulas: a brazilian bi-institutional experience. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2017;30:235-238.
• Ramachandran R, Gunasekharan V, Pillai AV, et al. Fibrin glue versus autologous platelet-rich fibrin - comparison of effectiveness on the cohort of patients with fistula-in-ano undergoing video-assisted anal fistula treatment. J Minim Access Surg, 2022;18(3): 443–449.
• Fisher OM, Raptis DA, Vetter D, et al. An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae. Colorectal Dis, 2015;17(7):619-26.
• Isik Ö, Gülcü B, Özturk E. Long-term Outcomes of Laser Ablation of Fistula Tract for Fistula-in-Ano: A Considerable Option in Sphincter Preservation. Diseases of the Colon & Rectum, 2020;63(6):831-836.
• Ege B, Leventoğlu S, Menteş BB, et al. Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients. Tech Coloproctol, 2014;18(2): 187–193.
• Emile SH. Recurrent anal fistulas: When, why, and how to manage? World J Clin Cases, 2020;6;8(9):1586-1591.
• Giamundo P, Geraci M, Tibaldi L, et al. Closure of fistula-in-ano with laser--FiLaC™: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis, 2014;16(2):110-5.
• Giamundo P, Esercizio L, Geraci M, et al. Fistula-tract Laser Closure (FiLaC™): long-term results and new operative strategies. Tech Coloproctol, 2015;19(8):449-53.