What is laser anal surgery?

Lasers are becoming used more and more frequently in various surgical procedures as a less invasive option. One novel technique that can be used as an option for treating anal fistulas is the FiLaC™ (Fistula Laser Closing) technique. This involves using a laser fibre to seal the fistula.

Why is it done?

The FiLaC technique is used to close anal fistulas – tunnels that can develop from the end of the bowel to the skin near the anus. Anal fistulas are usually caused when an anal abscess is drained of pus, leaving an empty channel behind, although they can also be complications of Crohn’s disease, diverticulitis, diseases such as tuberculosis or HIV, or complications of surgery in that area.

Anal fistulas can cause pain and irritation, and may leak a foul-smelling discharge. Sufferers may find blood and pus in their stools, and in some cases they may have difficulty controlling their bowel movements.

This unpleasant condition may be treated by a number of surgical options, ranging from cutting the fistula open so that it heals as a scar (fistulotomy) to blocking it with special glue or a cone-shape plug. Each procedure carries its own advantages and set of risks, and there is little consensus on which, if any, is the best option for the average patient.

The advantage of using a laser is that it is less invasive and causes minimal damage to the sphincter muscle, reducing the risk of incontinence after the procedure. However, the risk of the fistula recurring is higher than for some of the other treatments.

What does it involve?

Fistula laser closure involves introducing the laser fibre into the fistula from the outside and passing it through to the opening inside the rectum. Then, the laser is activated, causing the tissue around it to shrink as the proteins denature. The laser is slowly drawn back through the fistula at an approximate rate of 1 cm every three seconds, sealing the channel behind it. The internal opening is then closed with a suture and in some cases a skin flap.

How do you prepare for laser anal surgery?

Some preparation may be needed before the FiLaC procedure, including a rectal enema one day before the operation to prepare the bowel for surgery, and preparing the fistula itself. This may involve probing the fistula with a catheter, cleaning it with saline, and performing a resection of the internal opening, setting the miomucosal flap in place.

Aftercare

Patients are generally kept in the hospital for two to three days after the procedure, while their doctor and colorectal surgeon monitor their healing process. As with other treatments for anal fistulas, there is a possibility that fistula laser closing will fail and the fistula will reopen, in which case other options could be recommended by the doctor.

Alternatives to this treatment

Alternative treatments for anal fistulas include:

• Fistulotomy – the most common and arguably most effective treatment. However, if the fistula runs through the anal sphincter muscles, excising it with a fistulotomy could leave them damaged and leave the patient unable to control bowel movements.
• Seton techniques – using surgical thread to hold the fistula open to let it drain and encourage it to heal itself, without the need to cut into the anal sphincter muscles.
• Advancement flap procedures – similar to FiLaP, but using traditional surgical tools to cut or scrape out the fistula rather than a laser. A flap of tissue taken from the rectum is used to close the opening.
• Bioprosthetic plug – a cone-shaped plug made from animal tissue is used to block the internal opening of the fistula. NICE currently recommends performing this procedure as part of medical research, as more data is needed regarding its effectiveness.
• Fibrin glue – the only non-surgical option, this special glue helps to seal and heal the fistula.