Comparative outcomes of standard laser fistula closure (filac) versus filac combined with advancement flap in the treatment of complex anal fistulas

This study aims to compare the clinical outcomes of patients treated for complex anal fistulas using standard laser fistula closure (FiLaC) versus FiLaC combined with an advancement flap (+FLAP).

A retrospective review was conducted on patients treated for complex anal fistulas between January 2022 and December 2023. Treatments included standard FiLaC and FiLaC combined with an advancement flap. Main outcome measures included operation duration, hospital stay, postoperative pain [Visual Analog Scale (VAS) score], complications, and success rate.

A total of 47 patients were included in the study, with 25 in the standard FiLaC group and 22 in the +FLAP group. The +FLAP group had significantly longer operation times (29.7 ± 4.7 min versus 18.7 ± 4.0 min, p < 0.001) and hospital stays (16.2 ± 5.04 h versus 3.9 ± 2.3 h p < 0.001). Postoperative pain scores were similar between groups. The mean follow-up periods for the FILAC and +FLAP groups were 10.5 ± 3.5 months and 8.4 ± 4.0 months, respectively. The success rate was significantly higher in the +FLAP group (95.5% versus 72%, p = 0.03).

In this study, we found that, compared with FiLAC alone, combining FiLaC with an advancement flap may significantly improve primary success rates in the treatment of complex anal fistulas, and we believe this approach could be a valuable option for enhancing treatment outcomes in complex cases. The increased operation and hospital stay durations appear to be balanced by the higher success rates.