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EFFICACY AND SAFETY OF FILAC® WITH AND WITHOUT ADJUNCTIVE MEASURES IN ANAL FISTULA MANAGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Joao R. Duda
*1, Luiz A. Oliveira
2, Beanie C. Nunes
4, Stefano Baraldo
5, Luiza Fenelon
4, Murilo C. Carmo
3, Matheus C. Franco
6, Diogo B. Diedrich
3, Marcelo Costa
71Endoscopy Unit, Endoskope Diagnosticos Endoscopicos, Curitiba, Parana, Brazil; 2Universidade Federal da Bahia, Salvador, BA, Brazil; 3Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; 4Universidade de Sao Paulo, São Paulo, SP, Brazil; 5Hospital de Cancer de Barretos, Barretos, SP, Brazil; 6Hospital Sirio-Libanes de Brasilia, Brasilia, DF, Brazil; 7Unimed Sorocaba, Sorocaba, SP, Brazil
Background:
Surgical laser techniques like Fistula Laser Closure (FiLaC) are increasingly used for anal fistulas, but their efficacy, safety, and outcomes—especially with adjunctive measures—remain unclear. This study evaluates the outcomes of FiLaC, including healing and recurrence rates, postoperative complications, and adjunctive interventions.
Methods:
A systematic review and meta-analysis of controlled and observational studies on cryptoglandular anal fistulas was performed. MEDLINE, Embase, and Cochrane databases were searched. Outcomes included healing and recurrence rates, postoperative incontinence, reoperation, and infections, with subgroup analyses for FiLaC alone versus FiLaC with adjunctive measures such as seton placement and internal opening closure. Statistical analysis was conducted using RStudio.
Results:
Twenty-one studies encompassing 1,499 patients were analyzed. The overall healing rate was 56.8% (95% CI: 49.9–63.8%, I=87.27%, p<0.001). Recurrence occurred in 20.7% of cases (95% CI: 13.9–27.5%, I=92.12%, p<0.001). Postoperative incontinence was rare, at 0.9% (95% CI: 0.4–1.4%, I=2.9%, p=0.421). Adjunctive measures included seton placement in 57.2% (95% CI: 38.4–76.0%, I=99.78%, p<0.001) and internal opening closure in 57.3% (95% CI: 37.5–77.2%, I=99.95%, p<<0.001).
Conclusion:
FiLaC demonstrates moderate efficacy and a low recurrence rate with a remarkable safety profile, including minimal postoperative incontinence. Adjunctive measures such as seton placement and internal opening closure are commonly used to improve the outcomes. Further high-quality randomized trials are warranted to standardize protocols and clarify the role of adjunctive measures in optimizing outcomes
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