3rd Fistula surgery: 2nd Filac Surgery

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Dimitri71
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Date Joined Jul 2017
Total Posts : 138
   Posted 2/15/2018 5:11 AM (GMT -6)   
Hi to everyone and to Nofistulas, DBrookenz, Karen, Memmem, Jasontch who have paid particular attention to the FiLac matter. I hope you are well, looking forward to your news.
I had my first Filac surgery (post three months of draining seton) in October 2017.
Yesterday had the 2nd FiLac as again my (very conservative) CRS could not cut without a risk for potential gas incontinence.
Now I am trying to work, but obviously I am a little bit worn out.
If any of you reading this are going through a similar process or have anything to add, please give it a shout! I am very interested in hearing your news. All the best and get well.

dbrookenz
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Date Joined Feb 2017
Total Posts : 59
   Posted 2/15/2018 4:20 PM (GMT -6)   
Hey Dimitri,

That's awesome news! I'm happy you had surgery. Fingers crossed that things work out. We both know how complicated this fistula business can be! My recovery in the past 5 weeks has been up & down. I'm still draining from the external wound and I still feel like there's a fistula at work BUT my symptoms have been much less than prior to surgery and I feel a lot better in myself. I've lost the constant runny nose I had plus I'm getting to the gym and the pain & discomfort 2-3 hours after a bowel movement, while still there, is about 50% less than it was pre surgery. It's more bearable.

In any case, the very experienced nurse I saw 2 weeks ago said to me, 'These things take a long time to fix. Think of each surgery and healing process as another chipping away at it rather than a total end fix'. I think that's good advice. I really hope this surgery works for you my friend but if it doesn't then I hope it improves things a little bit more than before the surgery - maybe it moves the fistula to a position where you can get the fistulotomy or something like that.

Make sure you keep us updated on your recovery!

Dimitri71
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Date Joined Jul 2017
Total Posts : 138
   Posted 2/20/2018 3:45 AM (GMT -6)   
Thanks DBrookenz, very very nice to hear from you again.
Sorry to hear that you are still having drainage, hope things improve. Don't suffer in silence, let us know how you do.
My recovery post surgery is unfortunately similar to my last surgery....My wound is smaller since any abscesses were treated last time, but there is still the same (more or less) drainage.
My CRS said that drainage could continue for up to 4 weeks (as he did last time when FiLac failed...).
I am not sure I can believe this but no choice but to wait and see. I was hoping for something different this time but it seems that God has other plans for me.
All the best, Dimitri.

nofistulas
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Date Joined Oct 2017
Total Posts : 26
   Posted 2/21/2018 11:38 PM (GMT -6)   
I understand your pain dimitri. i've been going through this for a little over two years now and sometimes i feel like i'm going backwards. at this point i guess you have to wait a little before figuring out the next step. i think it was the right call to try the filac again. now you just have to wait and see. hope this one works out for you.

Its been about 4 weeks since my last surgery. Not really sure if i'm doing better or not. ive had so many different weird secondary symptoms, muscle aches, pains, swelling around my butt,hips and thighs for the past year and it feels even worse now. probably time to see another doctor for a second opinion. the fight continues.

Dimitri71
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Date Joined Jul 2017
Total Posts : 138
   Posted 2/22/2018 12:23 AM (GMT -6)   
Hi nofistulas and thanks very much for your kind words.
Hope things get better for you. What was the result of the fistulotomy?

Post Edited (Dimitri71) : 2/21/2018 11:26:05 PM (GMT-7)


dbrookenz
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Date Joined Feb 2017
Total Posts : 59
   Posted 2/24/2018 3:55 PM (GMT -6)   
Dimitri,

I'm sorry to hear that recovery hasn't gone as hoped. I do know this much, anyone (including doctors) who say drainage should stop within 4 weeks is, at best, very very hopeful. From what I read drainage from successful fistula surgery can occur anywhere from 4 weeks to 6 months! It's such a complicated little beast. Personally I do feel better after my last surgery. Not in a minor way either, I'm probably 50% better in myself physically. However the same symptoms, while lessened, still remain which leads me to think the surgery shrunk the fistula but didn't quite eradicate it.

Keep your head up, my friend. Conservative procedures are the way to go. In the end when I look back at this experience I will be fine with a couple of years with many treatments AND normal continence as opposed to one radical procedure and even the slightest loss of control. Just remember, each op is slowly chiseling away. keep us all up to date with things and what might come next when you know.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 2/25/2018 3:56 AM (GMT -6)   
Hi Dbrookenz and thanks for following on my case. Hope there is light at the end of the tunnel for both of us. And not too far ahead.
Apologize in advance for TMI below, but I have a question for you and anyone else who can reply:
I have a new strange evolvement. I am on my 3rd week of my 2nd Filac surgery: Prior to to the surgery I only had pus and or blood as drainage. Now pus drainage has decreased or become lighter (more watery, serus like drainage), no blood, however I find that now my fistula drains fecal matter after a BM. This is the first time I 've noticed that and is alarming me slightly. If anyone has any insight regarding this I would greatly appreciate.

Post Edited (Dimitri71) : 2/25/2018 3:02:44 AM (GMT-7)


dbrookenz
Regular Member


Date Joined Feb 2017
Total Posts : 59
   Posted 2/25/2018 8:19 PM (GMT -6)   
Hi Dimitri,

Don't worry, no such thing as TMI! As far as I'm aware many people with fistula have fecal matter through the fistula track. Can I ask if it comes out watery or is it small specks? From what I have read it's common with fistula. Better than your body works it through and expels it. It also suggests that your fistula has an internal opening still. Unfortunately this may mean the Filac surgery has likely failed (this is my uneducated opinion so take it with a pinch of salt). Does the fistula hurt more now this is happening? I know that you didn't have much pain when your fistula first appeared.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 2/26/2018 2:53 AM (GMT -6)   
Thanks dbrookenz. From what I've read, I agree with your assessment.
Sorry TMI again in order to reply:The fistula started hurting when I had some difficult BMs following the surgery. The pain occurs following BMs and is light, around 1/10. I think its decreasing as I am reverting to my usual BM business.
Drainage is reverting to becoming more liquid with pus again. Some tiny fecal matter small pieces or darker drainage appears in the gauze.
During this surgery the internal opening was sutured (no Flap) but I believe I saw the sutures one week post surgery coming out of the fistula. My CRS had told me in advance the sutures were temporary and expected to come out after one week.
I called my CRS regarding my new evolvements and he said that drainage should slowly subside. I wonder how on earth can this happen, as long as the IO is obviously still there!?
Unfortunately things have not worked out and have to start thinking about next steps again.
I have an appointment scheduled with my CRS on the 15th of March (1 month post op) to assess progress and hear his views. Then I will have to visit alternative CRSs- in all likelyhood, unless my current CRS tells me anything new e.g. (100% guarantee that he can cut or do a cutting seton, OR a new approach such FLAP/LIFT etc). I cannot have a 3rd FiLac surgery, that's for sure, unless they pay me!!! It's easy as there is no real wound but it is still a process and one expects results.
Anyway, the fistula business is surely tough, but we got to keep on going! All the best to everyone.

Post Edited (Dimitri71) : 2/26/2018 2:17:07 AM (GMT-7)


Dimitri71
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Date Joined Jul 2017
Total Posts : 138
   Posted 3/8/2018 7:59 AM (GMT -6)   
Hi a brief update; On 22nd day now; Went through a couple of days of almost no drainage (the best in six months); However, it has resumed again, not too bad though.
Will see CRS on 15/3 (on month post op) and will update.
All the best to everyone.

Newmommy26
Regular Member


Date Joined Nov 2017
Total Posts : 43
   Posted 3/8/2018 3:58 PM (GMT -6)   
Hu Dimitri

Sorry to hear it’s not been as successful as you had hoped. I’ve been following your posts with interest due to my complex RVF. I’m very much in the beginning of my treatment and am unfortunately nowhere near any surgical interventions to eradicate the RVF. I do like to keep tabs on the options once I get to that stage.

I was rather hopeful te Filac, I must say. Oh well.

My GI uses a number of CRSs, depending on what intervention is needed. One of them uses a biological paste that is inserted directly into the fistula to heal it from within. It’s not fibrin or any other glue. A patient with similar fistula to me went through the procedure and it had eradicated the fistula. I don’t really have any more details as it was just a brief mention (too early for me) but I was wondering whether this might be something for you to try?

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 3/9/2018 2:26 AM (GMT -6)   
Hi Newmommy, thanks for your comment. Sorry to hear you are dealing with a complex RVF. I wish I could help, but being a guy I don't know anything about it.
Thanks for your suggestion, I'm going to look into the biological paste.
To be honest, I am dealing with the fistula business for over 8 months now and I am growing a little sceptical in regards to the various spincter saving techniques..
My CRS told me that my fistula is not too complex (30% of external spihncter) so that I could do a cutting seton with very minor defects (gas incontinence perhaps)....

I am going to see him again next week and have to discuss all this in case FiLac does not work...

Kerry90
New Member


Date Joined Mar 2018
Total Posts : 3
   Posted 3/14/2018 10:22 PM (GMT -6)   
Hi Dimitri,

Would you mind sending me a direct email.
I would really like to ask you a few questions with regards to your experience with FiLaC and which CRS you saw. I also have perianal Crohn's disease and have been dealing with failed fistula treatments for 5 years now, so I am looking at other options (they don't have laser here in Canada so I'm looking into other countries).
I really hope you are doing well and your fistulas are healing up!

Please add your email under your profile. This is for your safety, as you need to be a member in order to view the address there versus spammers/bots that can access it in the open forum.

Thanks,

Post Edited By Moderator (FamilyGuy) : 3/15/2018 11:02:03 AM (GMT-6)


Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 3/15/2018 11:44 AM (GMT -6)   
Hi all,
saw my CRS to update post 1 month.
The fistula has not closed but he said it is now "superficial and does not involve a lot of sphincter".
He told me to wait until April 20th and if it doesn't heal, then go for a cutting seton operation.
So, I guess that's good news since my CRS is super careful about continence. He said he is not worried about flatus incontinence either "none of that". So overall great news some light at the end of the tunnel.
Hi Kerry90, I'd be verry happy to help and provide with any info you need. I will send an email once you have included your email in your profile, because I don't have it.
All the best to everyone, Dimitri.

Memmem
Regular Member


Date Joined Oct 2017
Total Posts : 22
   Posted 3/16/2018 7:54 PM (GMT -6)   
Hi Dimitri,

Hope you recover and this will be the final operation..I wish you the best man.I have a relative who had a cutting seton inserted 20 years ago,and it was successful,no loss of control as well.He mentioned he couldn`t turn the seton daily as his doctor suggested,so it took a bit longer.But it was long time ago so maybe that turning and cutting is not done anymore.

Would you be able to get a Mri with diffusion before as well so everything is mapped out again?

I will have my final operation loose seton removal in a month as well.

There was no leakage with me as I mentioned but there has been another complication in february(4th month with loose seton) which we don`t have a clue what it is about.The 12 o clock in the perineum where it has been cut many times(abscess and fistilotomy location as well)midway towards testicles is opening up and just bleeding.No other fluid,no pus,just tiny bit of blood.It`s far away from the seton,which is much closer to the rectum.A bit of collection of fluid/blood(i only see blood) collects in that location in a few days,then opens up empties out,closes then recollects again.Our best guess is that seton is traumatizing and hurting the tissue surrounding and the blood collects down there per gravity`s direction.Counting days to have a mri and see my surgeon.

As I am in canada again,the doctors again are as unhelpful as possible,telling me to go to ER if it turns into abscess and thats it.Ultrasound didnt tell anything other than that a collection of fluid.Mri is apparently has a a few months of wait time here.I suggest everyone here in canada to go to turkey,and do their operation there laser/vaaft/same day mri possibilities and its not expensive.Mri is 100 dollars same day,vaaft is the most expensive option around 3k with hospital stay from the top surgeon in the country.So disappointed with canada lol.

Post Edited (Memmem) : 3/16/2018 9:07:33 PM (GMT-6)


Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 3/17/2018 2:48 AM (GMT -6)   
Hi Memmem good to hear from you!!!

As I understand you currently have a draining seton which has more or less eradicated the main fistula? No need for a VAAFT anymore? That's great news.

In terms of the other opening it sounds like a superficial extension of the main fistula (no internal opening connection) or like a sinus which has been created through the rubbing of the seton. I had something similar in the beginning of this saga and my CRS laid it open during my first operation (July 2017) and then it healed. My fistula is also at 12'o clock and the extension was heading towards the same direction, so sort of scary to put it mildly! My CRS told me at that time that this would be no problem and he was right, it has stayed fully healed since that date (mine was connecting to the external fistula opening at skin level, very superficial).

Thanks about the story with your uncle, my CRS told me the Cutting Seton will stay on for 15-20 days. He did not tell me about rotating it, but we'll go into more details on April 20th when I'll meet him. I thought about the MRI as well to be honest (I had one and a 3D ultrasound as well during 6/2017) Its fairly easy to get an MRI in Greece and not too expensive.

However, prior to my 2nd Filac I went and consulted another prominent CRS (CRS B) who suggested that my fistula was "simple, like I cought a cold" or something and that he could easily perform a fistulectomy. I suggested an MRI to him and he said "no need, in case I see something strange during the operation, I'll perform an 3D Ultrasound on the spot, which is better. However this is simple, don't worry".
Following this visit to CRS B, I realized that my fistula was in a better shape than it had been prior to the first operation, possibly due the distalizing achieved by my first FiLac (or the draining seton) and the good job that my CRS A had done with cutting the fistula extension.

So I decided to go for another FiLac with my CRS A...And post this 2nd FiLac surgery, CRS A who is very-very careful in regards to continence, says the fistula has now become very simple and superficial. I asked him about continence problems and he said impossible...He also thinks that MRI is useless for my case. But I get your point, better safe than sorry...I may call him over the phone and ask him again (instead of directly confronting him with it and going into discussions).

CRSs are a creature of their own. For example, CRS A will not cut, he simply uses cutting seton, even for more superficial fistulas. CRS B suggested a fistulectomy...Really, the fistula business is very strange...And we pay to be guinea pigs!!

Post Edited (Dimitri71) : 3/17/2018 3:08:51 AM (GMT-6)


Memmem
Regular Member


Date Joined Oct 2017
Total Posts : 22
   Posted 3/18/2018 8:17 PM (GMT -6)   
Hi Dimitri I am happy that your fistula is in a better shape!One day this will be over ehsmile

Also good to hear your crs having a conscious approach,it is even hard to find such one.20 days of seton doesnt so bad too,it will pass fast,in perspective of the whole saga.smile

I tend to get the Mri to ease my mind mostly,independently from the doctor then giving him the result paper.If a doctors report is needed,a family doctor could prescribe it,they are easier to persuade but in turkey you dont need one.Maybe you can ask for 3d endo again during the operation if not mri just to be through but i dont think it would change the precedure right now.

I am having further complications these last days that there is little pus coming out right now (gathers a bit in a few hours)out of seton at 12 o clock and also 1.5cm higher again at 12 o clock.My guess is the channels are connected..The upper point was the first seton entry position but it cut down further down in the first few weeks.I can also feel the inflamation pain,which is bearable so far..It`s interesting there was no pus and no complications for the first 4 months but now its party time again.smile

I am thinking of jumping to a plane and see my surgeon but it is probable he is gonna say `oh good this means we should keep the seton there,hang in there buddy see you in a month`.It feels like he would do the same surgery again so he wouldnt operate now..So I am thinking of using antibiotics for a few weeks keeping things calm and most importantly opening up my schedule.

As a side note,there is a prominent fistula surgeon who only does fistulas in istanbul as well,who mostly uses filac only.He said no seton for me,filac will be enough.He operates with filac every week after the first week for a month or so depending on the follow ups.All without general anesthesia.I opted out for seton+vaaft to be through though.God knows what would have happenedsmile

Right now,I guess the antibiotics would help with the inflamation too as there is no abscess?I am worried about how much antibiotics I used in the last year though,probably 2-3 months worth of it.This kind of times with amoxicillin seems safe according to a few papers I read now.Will decide by tomorrow.

Post Edited (Memmem) : 3/18/2018 8:41:16 PM (GMT-6)


Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 3/19/2018 3:50 AM (GMT -6)   
Hi Memmem, I think draining pus and other gross staff (while having a draining seton on) is absolutely normal. That's what a fistula does....

I don't think you need antibiotics unless you have an asbcess (even then the only cure is I&D, not antibiotics).

I have been only prescribed antibiotics for a week (immediately post surgery). So ask your CRS prior to taking them since you may not need them. If the fistula drains you cannot get sepsis.

Good luck with your op in one month. VAAFT is great, in my view possibly better than FiLac since they visualize the fistula with a camera.

Again, I have become very sceptical of the sphincter saving techniques and their supposed success rates. I am sure there is a selection bias in terms of the patients. Otherwise how can you explain the big deviations on various studies and their results (concerning both for FiLac and VAAFT);
In any case, even if they fail, both FiLac and VAAFT "distalize" fistulas (that's the term they use to describe that the fistula involves less muscle and becomes more superficial).

As a result - worst case scenario - you can apply successfully the most "ancient" methodssmile.
In case a fistulectomy or cutting seton was not absolutely safe, I would persist with VAAFT or FiLac.
Perianal Fistula since 06/2017. So far draining seton and two FiLac surgeries (last in February 2018). Appraising the possibility of a cutting seton. Looking forward to beating this and to helping others struggling with perianal fistulas.

Memmem
Regular Member


Date Joined Oct 2017
Total Posts : 22
   Posted 3/22/2018 5:57 PM (GMT -6)   
Hey Dimitri,thanks for reassuring that things were ok and the information regarding it,it eased my soul..Also the day after it,the pus stopped leaking and the canal started closing down.The MRi showed just inflamation in the seton track.

I visited my doc and he said it is time we took the seton out and the seton did its job and things are looking good.He said the complication and the opening is not a big deal and happens due to feces going into the seton canal.Funny thing,I found an exact same situation on the internet that a person experienced ,but there was no follow up to it.I guess it is common-ish.

He was amuzed by my experience visiting the csr in canada but not surprised at all,he told me that this is typical also in other countries including usa and germany and many others as well.He made the remark that if he were to turn the patients down and referred to ER etc. that had previous surgeries and complicated cases like them he would turn away %90 percent of his patients.He said this is due to the volume of patients and not due to the quality of the surgeons though.

The day after that I entered surgery,writing this post at hospital right now as there is one night stay..

My Csr seems to have applied every technology known to man in this surgery.smileHe wrote very detailed as I think he knows I like to track what is going down.He used vaaft first and found it split into two ,lateral and anteriour which (the lateral track)didnt show up in the mri.Used vaaft,filac and laft to curate the tracks,lots of processes there to clean things up,more than I can follow up and known how it is done,as he wrote pretty detailed and they are applied one top of another,I am impressed.Lastly he made a big incision in the 12 o clock path between the upper fistula opening and anus laying it open for it not to repeat again.He prescribed flaggyl+cipro now.Only cleaning with soap for the incision area,no baticon.

Breath and farts are held,hoping this will do the trick.smileAs I had a big lay open like this before(preetty deep and scary to look,4cm long to 3cm deep as far as I can look) it will take 10 days to come down and close up around the 15th day.Pain management until then,500mg parasetamol every 8hours will do the trick .As he doesnt advocate baticon to be applied daily to the fresh wound(we did it last time) which was extremely painful, I am happy now.

Sorry about hijacking your thread and I hope for the best for you as well my friend.Let us know how it all goes down.Hoping for the best.

Post Edited (Memmem) : 3/22/2018 6:15:30 PM (GMT-6)


Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 3/23/2018 3:44 AM (GMT -6)   
Hi Memmem, great news, you really did it very quickly!!! Hope you get a speedy and full recovery.
Great to have this assortment of VAAFT and FiLac.
Both are good methods to kill the monster, or at least slowly, yet surely get the fistula exhausted!!
All the best and Keep us posted!
Perianal Fistula since 06/2017. So far draining seton and two FiLac surgeries (last in February 2018). Appraising the possibility of a cutting seton. Looking forward to beating this and to helping others struggling with perianal fistulas.

Memmem
Regular Member


Date Joined Oct 2017
Total Posts : 22
   Posted 3/24/2018 11:34 PM (GMT -6)   
Thanks Dimitri!Same to you as well, I ll be following your updates and hope to hear healing taking place soon..

After a few days from the operation,seems like I was optimistic about the excision closing up in 15 days,csr told me it will take approx 3-5 months to fill this area,it really is a cave.He told me he did it to not have a relapse in the following months by any chance as my schedule is very strict in these times,I am also hoping it adds more preventative elements.

I would prefer it to be closed sooner though ,need more pain management this time round with the cavern,used to use only cataflam for the prev. excisions.Now need apranax fort every 12 hours which the csr prescribed.Oh well,time to buckle up for a few months and see how it pans out. smile

Kerry90
New Member


Date Joined Mar 2018
Total Posts : 3
   Posted 3/25/2018 10:43 PM (GMT -6)   
Wishing you speedy and complete recovery Memmem!

Dimitri, sorry I fixed that now so my email should show up on my profile. Thank you for providing all this information about your experience!

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 3/27/2018 12:46 PM (GMT -6)   
Memmem, patience, that's the name of the game. 3-5 months is a lot and since you mention a "cave" did you have a fistulectomy as well? Hope it all goes well.

Kerry90, thanks I've sent you an email. hope I can help.
Perianal Fistula since 06/2017. So far draining seton and two FiLac surgeries (last in February 2018). Appraising the possibility of a cutting seton. Looking forward to beating this and to helping others struggling with perianal fistulas.

Memmem
Regular Member


Date Joined Oct 2017
Total Posts : 22
   Posted 3/27/2018 7:52 PM (GMT -6)   
You are right about patience Dimitri,its better to leave it to time and see how it pans out,than to constantly trying to figure it out..i think I did have a fistulectomy meaning csr cut until where it comes close to sphincters and he used laser after that.He used the term Pit excision for that..I will ask him when I see him in a week,I am pretty sure he knows what he is doing but never hurts to know.

Post Edited (Memmem) : 3/27/2018 8:03:29 PM (GMT-6)


Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 138
   Posted 4/12/2018 5:09 AM (GMT -6)   
Hi everyone! Memmem, how are you?
To all people here following on the FiLac matter, there is a new study (march 2018) on FILAC success and the results are not great, actually dissapointing (40% success only!!). Maybe this explains my two-time FiLac failure, but the disparity between this and previous studies is troubling, in any case. I quote below the study abstract.
To update on my situation, I'm seeing my CRS, to start planning for a cutting seton op next week. Hope this goes better.

Closing Perianal Fistulas Using a Laser: Long-Term Results in 103 Patients
Article in Diseases of the Colon & Rectum 61(5):1 · March 2018 
Abstract
Background: Primary closure of the fistula tract using energy emitted by a radial fiber connected to a diode laser is a novel procedure for treating perianal fistulas. Objective: The aim of this study was to determine the long-term effectiveness of this new technique. Design: The surgical objective was to seal the fistula tract using laser energy. Settings: The study was conducted at a single day-case surgery center. Patients: Between April 2012 and June 2016, 103 consecutive patients with primary or recurrent perianal fistula underwent a laser closure procedure using a 12-watt laser emitting at a wavelength of 1470 nm. Main outcome measures: Patients were classified according to the Park classification, and healing was evaluated based on the perianal fistula disease severity score. Results: Among the 103 patients treated using the laser closure procedure, 82 (80%) were men and 21 (20%) were women. The median age of the patients was 43 years (range, 18-78 y). Fifty-three patients (52%) had previous perianal fistula repair surgery. Based on the Park classification, 56 patients (54%) had intersphincteric fistula, 29 (28%) had transsphincteric fistula, 11 (11%) had suprasphincteric or extrasphincteric fistula, and 7 (7%) had superficial perianal fistula. Based on the perianal disease severity score, 41 patients (40%) obtained overall complete healing, 38 (37%) had persistent symptomatic drainage, 20 (19%) had slight drainage with minimal symptoms, and 4 (4%) had painful symptomatic drainage. Limitations: This was a retrospective analysis of noncomparative data with a lack of formal prospective continence assessment. Conclusions: Closure of perianal fistulas using a laser should be considered as a treatment option but with modest expectations. Although our complete healing rate was not as high as in earlier studies, this technique is a reasonable option with nearly no risk of sphincter damage when treating perianal fistulas.
Perianal Fistula since 06/2017. So far draining seton and two FiLac surgeries (last in February 2018). Appraising the possibility of a cutting seton. Looking forward to beating this and to helping others struggling with perianal fistulas.
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