الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Perianal fistula is a common anorectal disease that is associated with a decreased quality of life. Despite the advances made in recent years, the treatment of perianal fistula remains a challenge due the difficulty of maintaining continence while preventing recurrence.
Effective therapy may lead to faecal incontinence particularly in the treatment of high transphincteric and intersphincteric fistula. Most patients are more interested in preserving continence than in definitive fistula treatment.
Their pathophysiological basis is the cryptoglandular hypothesis, according to which an infection of the intersphincteric glands leads to abscess formation, which points to the surface of the perianal skin.
While simple perianal fistula can be treated with lay open fistulotomy with healing rates up to 98%, complex perianal fistula treatment remains challenging, as perianal fistula may recur, or the patient’s continence status may be compromised. In the last 2 decades, the treatment of perianal fistula has progressed from simple fistulotomy to a diversity of intricate sphincter-preserving techniques, this was primarily in response to concerns about the unacceptably high rates of incontinence associated with fistulotomy.
Numerous surgical procedures have been introduced for the treatment of perianal fistula including ligation of intersphincteric fistula tract (LIFT), anal advancement flaps, injection of fibrin glue, collagen paste or autologous adipose tissue, fistula plug, video-assisted anal fistula treatment (VAAFT) and fistula laser closure (FiLaC).
The FiLaC technique¬¬ involves the identification of the internal opening, sometimes by the injection of hydrogen peroxide or methylene blue from the external opening, debriding the fistula tract with a curette, closure of the internal opening, insertion of a plastic hollow catheter using a guide-wire, insertion of a disposable laser fibre into the catheter with its tip emerging at the internal orifice, and continuous delivery of laser energy circumferentially within the fistula tract while withdrawing it at a rate of 1 cm per 3 s.
The parameters of the laser energy can be regulated depending on the width of the tract.
The aim of this review is to do a systematic search and meta-analysis of the available literature to assess the outcome of FiLaC in the treatment of non-branching perianal fistula. The main objective is to learn about the healing rates and complications associated with FiLaC to reach a conclusion about its overall safety and efficacy.
In the current systematic review meta-analysis, a total of 14 studies were included with a total of 809 patients, out of them 11 studies were retrospective, 1 prospective study, 1 cohort study and 1 case series.
The main results of the study revealed that:
• A total of 809 cases were included with mean age 43.5 years.
• Mean follow up was 21.8 months and regarding site of l superficial (7) esion was Intersphincteric fistula (144), Transsphincteric fistula (448), Suprasphincteric fistula (62), superficial (8), extrasphincteric (1).
• Number of cases had pain postoperative was 27 cases, mean Length of stay (day) was 1.05, 1 case had urine retention, and success cases was 427, failure in 373.
• A total of 300 complications were founded in form of infection, hemorrhage, wound healing complications, ileus and as regard recurrence founded in 258.
• Pain post-operative assessed in 5 studies with event rate 9.5% and significant heterogeneity between studies.
• Success assessed in 14 studies with event rate 52.9% and significant heterogeneity between studies.
• Failure assessed in 14 studies with event rate 45.955% and significant heterogeneity between studies.
• Complications assessed in 14 studies with event rate 2.7% and significant heterogeneity between studies.
• Recurrence assessed in 14 studies with event rate 30.672% and significant heterogeneity between studies.
• Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.