الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 45 |  |  |
| | | from | 45 | | |
Abstract
Optimal surgical management of fistula-in-ano must consider a balance between post-operative fecal incontinence and recurrence rates. While lay-open technique remains the gold standard of care for simple cases of fistula in-ano with low recurrence rates, the newly described options including LIFT and FiLaC provide promising results about fecal continence with better quality of life due to low pain scores and rapid wound healing.
This study is a prospective comparison between FiLaC with LIFT and Lay-open techniques that included thirty patients with simple trans-sphincteric fistula-in-ano in each group admitted to Alexandria colorectal surgery unit. Pre-operative recording was done for demographic data and previous perianal surgeries. Clinical anal examination and assessment of fecal continence were done. Routine laboratory investigations were ordered and written informed consents were obtained.
Lay-open entails muscle division by a diathermy probe to fully visualize the fistula tract and ensure its adequate mechanical drainage by a curette under vision. LIFT entails separation of the tract proximally from IFO followed by the photocoagulation energy of FiLaC which is t¬¬ransmitted through a radial-emitting fiber probe connected to a Laser device to cause protein denaturation of the granulation tissue and epithelial lining with subsequent local tissue shrinkage that seals the tract with low surgical trauma to the sphincteric mechanism.
After a regular follow-up for six months, recurrence rates were near to each other, but a statistically significant difference was found in favor of FiLaC with LIFT technique in terms of low pain scores, minimal fecal incontinence rates, rapid wound healing, and better quality of life.
Finally, FiLaC is a blind procedure that needs selective cases without side tracts or deep pockets of anal abscesses to minimize the recurrence rates. Also, the high cost is no longer an obstacle in the medical practice provided that the machine can be shared among different specialties in the same institution.