The FiLaC (Fistula Laser Closure):technique of laser closure of fistula-in-ano

The treatment of anal fistula is a real challenge in anal surgery because of a significant risk of failure or recurrence and especially of anal incontinence. Fistulotomy, in its different forms, is the treatment of choice but alternatives are sometimes necessary in cases of risk of anal continence. These alternatives, called sphincter-saving procedures are numerous, but their success rates are lower than for fistulotomy. The FiLaCTM (Laser Fistula Closure) is a new and simple technique of anal fistula treatment consisting in ‘‘burning’’ the fistula tract radially with a laser. The literature is still poor with some open and heterogeneous studies, but their results are encouraging, with a success rate ranging from 70% to 80% without negative impact on anal continence. Our own experience is going in the same direction with a 89% cure rate over the short term. More rigorous studies with a larger number of patients are needed to support these promising preliminary results of FILACTM, to compare the technique with other sphincter-saving procedures and to define its place in therapeutic strategy.