FISTULA-IN-ANO TREATMENT: CLOSURE WITH LASER OR STANDARD FISTULOTOMY FOR LOW-LYING FISTULA – A SINGLE-CENTER PROSPECTIVE COMPARATIVE STUDY

Abstract

Background: Fistula-in-ano is a frequent benign anorectal condition, commonly arising from cryptoglandular infection which requires surgical management to control purulent discharge, pain, and recurrent sepsis. Fistulotomy remains the standard approach for simple low fistulas but may cause greater postoperative pain and longer healing time because wound heals by secondary intention, and continence outcomes depends on type of fistula and length of tract. Laser-based fistula closure techniques have been introduced as sphincter-preserving alternatives with encouraging short-term outcomes in systematic reviews.

Objective: To compare postoperative pain, healing time, recurrence, and continence outcomes between standard fistulotomy and laser fistula surgery using a 1470-nm diode laser.

Methods: This prospective comparative study enrolled 60 patients with primary low lying fistula-in-ano and allocated them equally to fistulotomy (Group A) or laser fistula surgery (Group B). Pain was assessed using VAS on postoperative day 1; healing time was measured as weeks to complete epithelialization; recurrence was assessed at 12 weeks; continence was evaluated using the Wexner score.

Results: Mean VAS was lower in the laser group (3.1±1.2) than fistulotomy

(5.8±1.5; p<0.001).  Healing time was shorter with laser (4.3±0.9 vs 6.1±1.2 weeks; p<0.01). Recurrence occurred in 2/30 (6.7%) vs 6/30 (20%), respectively (p=0.12). No case of fecal incontinence occured whereas flatus incontinence was reported in fistulotomy.

Conclusion: Laser fistula surgery is a sphincter-preserving alternative with better pain scores and faster healing, with comparable short-term outcomes.