Purpose: Anal fistula disease still impairs the quality of life of thousands of patients. Despite its efficacy, the traditional surgical treatment with fistulotomy presents high rates of fecal incontinence due to division of the external sphincter. Therefore, new sphincter preserving techniques, like Fistula Laser Closure (FiLaC™), that include surgical interventions combined to new technologies and biomaterials have risen. The aim of the present meta-analysis is to present the efficacy and the safety of FiLaC™ in the management of anal fistula disease.
Methods: The present proportional meta-analysis was designed using the PRISMA and AMSTAR guidelines. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases from inception until November 2019.
Results: Overall, eight studies were included that recruited 476 patients. The pooled success rate of the technique was 63% (95% CI = 50 to 75). The pooled complication rate was 8% (95 CI = 1 to 18). 66% of the patients suffered from a transphincteric type of anal fistula, while 60% of patients had undergone a previous surgical intervention, mainly a seton (54%). The majority of the patients suffered from a cryptoglandular fistula. Operation time and follow-up period were described for each study.
Conclusion: FiLaC™ seems to be an efficient therapeutic option for perianal fistula disease with an adequate level of safety, that preserves quality of life for patients. Nevertheless, randomized trials need to be designed for the comparison of FiLaC™ with the most common procedures for the management of anal fistulas
