A systematic review and meta-analysis of the safety and efficacy of fistula laser closure

Tech Coloproctol. 2020 Apr;24(4):265-274. doi: 10.1007/s10151-020-02165-1. Epub 2020 Feb 17.


Background: Fistula laser closure (FiLaC) is a novel sphincter-saving technique for the treatment of fistula-in-ano. The aim of this study was to assess the safety and efficacy of the FiLaC procedure.

Methods: Databases including PubMed/Medline, Scopus, Web of Science, and Embase were searched for articles assessing FiLaC. All studies including case series and comparative studies reporting the outcome of FiLaC in the treatment of fistula-in-ano were considered eligible. The main outcomes were healing rates of fistula laser closure, postoperative complications including incontinence, technical aspects of the procedure and failure of healing.

Results: Seven studies were included. There were a total of 454 patients, 69.1% with a transsphincteric fistula-in-ano and 35% with recurrent disease. The median age of the patients was 43 years (range 18-83 years). The median operation time was 18.3 min (range 6-32 min). With a median follow-up of 23.7 months, the weighed mean rate of primary healing was 67.3% and the overall success when FiLaC was reused was 69.7%. The weighted mean rate of complications was 4%, all of them were minor complications and the weighted mean rate of continence affection was 1% in the form of minor soiling.

Conclusions: FiLaC may be considered an effective and safe sphincter-saving technique for the treatment of fistula-in-ano with an acceptable, low, complication rate. However, well-designed randomized control trials comparing FiLaC with other techniques are required to substantiate the promising outcomes reported in this review.

Keywords: Anal fistula; FiLaC; Fistula-in-ano; Laser; Outcome; Perianal fistula.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anal Canal
  • Humans
  • Lasers
  • Middle Aged
  • Operative Time
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Rectal Fistula* / surgery
  • Treatment Outcome
  • Wound Healing
  • Young Adult