Last Updated on December 6, 2022 by Dr. Shikha Shiromani
Laser treatment or open surgery can be very effective in the cases of fistula. Choosing the procedure depends upon the location of the fistula, the length of the fistula and other factors. Unfortunately, both of these procedures don’t have a 100% success rate. Sometimes, the surgery can be unsuccessful and there can be a chance of reoccurrence.
What is a better fistula treatment: laser or open surgery?
Fistulotomy surgery has been arguably considered the most effective treatment for fistula. However, various other forms of treatment to treat a fistula have now started to show their effectiveness. Whether to choose laser or open surgery for fistula is the doctor’s call. It depends upon the age, sex, previous fistula surgery, location of the fistula, and length of the fistula tract.
According to the NHS, the fistula is sealed with a small laser beam during the radially emitting laser fibre treatment. Even though there have been no big safety concerns till now, there are still a few uncertainties about how well it works on the patients. Research states that to treat a transphincteric anal fistula, laser closure is considered to be very effective and safe. The only major prognostic factor while using a laser to close the fistula is the length of the fistula. It is believed that there will be a better outcome if the fistula is short compared to a longer one.
Does laser or open surgery treat the fistula entirely?
In most cases, surgery followed by proper post-operative care cures the problem, but in some instances, there are chances of unsuccessful surgery or reoccurrence of the fistula.
Fistula healing depends on age, sex, previous fistula surgery, location of the fistula, and length of the fistula tract.
Research published in the JAMA Network concluded that it is challenging to treat an anal fistula due to the anatomical location of the fistula. The other challenge is the risk involved in postoperative stool incontinence and septic complications. Even though fistulotomy is the most common procedure opted for removing the fistula, it doesn’t have a 100% success rate, and its success rate ranges between 87% to 94%.
Moreover, certain fistulas, especially anal fistula, are usually associated with a high risk of recurrence and fecal incontinence. The risk factors for the recurrence of anal fistula after surgery include preoperative, intraoperative, and postoperative factors. In 2019, The International Journal of Surgery published that the reported rate of recurrence after anal fistula surgery is between 3 and 57%, and this number varies as per the different procedures.
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