Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double-blinded randomized controlled trial
Document Type
Article
Publication Date
8-1-2024
Abstract
Background: Prior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient-reported outcomes, such as postoperative pain, which could influence surgical choice. Objective: To compare pain scores at 6 and 24 h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula. Design: Prospective, double-blinded randomized controlled trial. Settings: A quaternary hospital in Malaysia. Patients: Patients aged 18-75 years with high transsphincteric fistulas. InterventionFistula laser closure versus ligation of the fistula tract (LIFT) treatment. Main Outcome Measures: Pain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi-square, Fisher's exact test, student t-test, or Mann-Whitney with p < 0.05 denoting statistical significance. Results: Fifty-six patients were recruited (laser, n = 28, LIFT, n = 28). Median pain scores for laser versus LIFT at 6 h postoperatively were 1.0 versus 2.0 (Rest, p = 0.213) and 3.0 versus 4.0 (Movement, p = 0.448), respectively. At 24 h, this reduced to 2.5 in both arms at rest (p = 0.842) but increased to 4.8 versus 3.5 on movement (p = 0.383). Median operative time for laser was significantly shorter (32.5 min) than LIFT (p < 0.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, p = 0.181) but treatment failure was similar (54% vs. 50%, p = 0.71). No patients developed postoperative incontinence. Mean SF-36 scores increased from baseline (67.1 +/- 17.0; 95% CI 63.6-82.4 vs. 71.3 +/- 11.4; 95% CI 64.0-75.0) to 6 months postoperatively (77.7 +/- 21.0; 95% CI 57.0-80.3 vs. 74.0 +/- 14.3; 95% CI 67.6-81.4) regardless of the type of surgery (P > 0.05). Limitations: Patients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy. Conclusion: Laser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL.
Keywords
colorectal surgery, laser fistula closure, LIFT, pain score, quality of life, transsphincteric anal fistula
Divisions
surgerydept
Funders
Universiti Malaya
Publication Title
World Journal of Surgery
Volume
48
Issue
8
Publisher
Wiley
Publisher Location
111 RIVER ST, HOBOKEN 07030-5774, NJ USA