COMBINATION OF LIFT AND FILAC FOR THE TREATMENT OF COMPLEX ANAL FISTULA: CASE REPORT

Case Presentation A 62-year-old male patient with coronary artery disease and hypertension presented with a one-year history of anal discharge. A colonoscopy revealed purulent discharge from an internal opening, prompting a 3D Endoanal Ultrasound, which documented a complex transsphincteric anorectal fistula involving 77% of the external anal sphincter. The patient expressed a strong preference for preserving continence and opted for a sphincter-preserving technique. The patient underwent the Ligation of Intersphincteric Fistula Tract (LIFT) procedure combined with the FiLaC (Fistula Tract Laser Closure) technique for the external tract. A radial fiber with a 1470-nanometer diode laser was used, delivering energy at 100 joules/cm. The patient experienced an uneventful early postoperative period without complaints. However, on the 30th postoperative day, purulent discharge was noted from the surgical wound, which was managed with oral antibiotics. Currently, the patient is asymptomatic, with complete resolution of the anorectal fistula.

Discussion Various surgical options are available for treating anorectal fistulas, particularly complex cases where recurrence rates and the risk of postoperative incontinence remain significant challenges. In this context, the increasing interest in novel therapies, such as diode laser application, combined with multiple techniques, represents a promising approach for managing anorectal fistulas while preserving sphincter function.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025