FISTULA LASER ABLATION FOR ANAL FISTULAS (systematic review)

AIM: to reveal fistula healing incidence after application of FiLaC™ technique and factors that can affect it. MATERIALS AND METHODS: when searching electronic medical databases for publications that evaluated the results of the FiLaC™ technique in the treatment of anal fistula, 6 studies were selected, corresponding to the search queries. The search was carried out taking into account the principles of systematic literature reviews and meta-analyses (PRISMA). The time interval for searching publications was between 2011 and October 2018. In the publications included in the analysis, the following parameters were evaluated: general characteristics of the study groups, technical aspects of the FiLaC™ technique, the site of the fistula in relation to the anal sphincter, the option of closing the internal fistula, the incidence of healing and recurrence of fistula, the duration of the follow-up period after surgery, re-operated cases of fistula recurrences. RESULTS: taking into account the data obtained in the analysis of the selected studies, the mean incidence of fistula healing was 64.5% (40.0-88.2)%. It was found that the only factors that can be used to assess their impact on the incidence of fistula healing were: the gender and the variant of the fistula site in relationship to the anal sphincter (transsphincteric/extrasphincteric). Statistical analysis and evaluation of the odds ratio revealed no effect on the treatment result of the above parameters. CONCLUSION: the analysis of the data showed that FiLaCis mainly indicated for the treatment of patients with extrasphincter and transsphincteric anal fistulas. The method can be recommended as a sphincter-sparing treatment in patients with initially weakened anal sphincter function and, consequently, with a high risk of anal sphincter insufficiency in the application of traditional techniques. Further evaluation of the treatment results in the treated period and their comparison with the results after other variants of coagulation of the fistula walls is required to obtain a clearer understanding of the effectiveness of the FiLAC technique.