Initial experience of fistula laser closure in patients with fistula in ANO in a developing country: A prospective cohort study from Pakistan.

Abstract

Objective: To evaluate the initial experience, efficacy, and outcomes of Fistula Laser Closure (FiLaC) in the treatment of patients with fistula in ano in a Pakistani healthcare setting. Study Design: Prospective Cohort study. Setting: Faisal Hospital, Faisalabad. Period: February 2022 to January 2025. Methods: A total of 243 patients aged 20-60 years with clinically and radiologically confirmed fistula in ano were included using convenience sampling. Patients were classified according to Parks’ classification and followed up at 3, 6, and 12 months post-operatively to assess healing and recurrence rates. Results: Among 243 patients, trans-sphincteric fistulas were most common (41.1%, n=100), followed by extra-sphincteric (24.7%, n=60), intersphincteric (22.6%, n=55), and supra-sphincteric (11.5%, n=28) fistulas. The overall primary healing rate was 69.96% (n=173), with primary failure in 30.04% (n=70) patients. Healing rates varied by fistula type: trans-sphincteric 37% (n=37), extra-sphincteric 16.50% (n=10), intersphincteric 12.3% (n=7), and supra-sphincteric 4.10% (n=2). Among the 70 patients with primary failure, secondary healing after repeat laser treatment was achieved in 23% (n=56), with a secondary failure rate of 7% (n=17). Simple fistulas demonstrated superior outcomes compared to complex fistulas. Conclusion: FiLaC appears to be a promising sphincter-preserving treatment for fistula in ano in a developing country context, with satisfactory overall primary healing rates, particularly in patients with simple fistula types. The secondary healing rate following repeat treatment suggests potential for successful outcomes after initial failure.