Gispen, Willem (2020) Treatment of anorectal fistula with the Fistula-tract Laser-assisted Closuremethod (FiLaC™) in comparison with standard methods First results of a follow-up study in three centres in the Netherlands. thesis, Medicine.
Full text available on request.Abstract
Background: An anorectal fistula is a passageway between the rectum and the perianal skin. The complexity is dependent of the amount of external and/or internal anal sphincter involved by the fistula tract. The goal of treatment is to eradicate the fistula tract combined with primary healing without recurrent disease and without loss of sphincter function and continence. Treatment options are fistulotomy for simple fistulas and sphincter-sparing treatment for complex fistulas. Current standard sphincter-sparing treatment in the Netherlands is the MAF procedure (mucosal advancement flap) or the LIFT procedure (ligation of intersphincteric fistula tract). A novel treatment is the fistula-tract laser-assisted closure method (FiLaC™), showing promising results. To date, no comparative studies have been performed regarding the FiLaC™ method and current standard treatments. Method: This study is a multicentre non-randomised retrospective cohort study. Primary as well as recurring fistulas, treated with FiLaC™, MAF or LIFT, were included in the study, where MAF and LIFT were combined in the control group. Exclusion criteria were Crohn’s disease, age below 18 years old at the time of the study or a lack of information concerning the primary healing or recurrence. The primary outcome measurements were primary and secondary healing rates as well as the recurrence rate. Secondary outcomes were the duration of healing and the follow-up duration. Objective: The objective is to perform a retrospective cohort study to investigate if there are any differences in healing and recurrence rates between patients with an anorectal fistula, either treated according to the current treatment guidelines in the Netherlands or with the FiLaC™ method. Results: 104 complex fistulas were treated with the FiLaC™ method and 68 with either the MAF or LIFT procedure. No significant differences in patient characteristics were found. No significant differences in primary healing, secondary healing or recurrence rate were found. Primary healing was slightly lower in the FiLaC™ group (53.8% versus 60.3%), but after a second treatment the healing rate was higher (89.4% versus 84.7%). Duration of healing was also non significantly different between the groups. Conclusion: The FiLaC™ method is not inferior to current standard treatments of anorectal fistulas, i.e. the MAF or LIFT procedure. It also has shorter operating times and less post-operative incontinence. Although promising, further research is necessary. Preferably a randomised controlled trial or a prospective comparative cohort study. Outcomes should be measured at pre-determined follow-up intervals and consist of healing and recurrence rates but also incontinence and complication rates and the changes in quality of life.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Dr. Furnée, E.J.B. and Dr. Schouten, R. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Sep 2023 11:42 |
| Last Modified: | 25 Sep 2023 11:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3693 |
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