Comparative Outcomes of Standard Laser Fistula Closure (FiLaC) versus FiLaC Combined with Advancement Flap in the Treatment of Complex Anal Fistulas

Abstract Aim: This study aims to compare the clinical outcomes of patients treated for complex anal fistulas using standard laser fistula closure (FiLaC) versus FiLaC combined with an advancement flap (+FLAP). Methods: A retrospective review was conducted on patients treated for complex anal fistulas between January 2022 and December 2023. Treatments included standard FiLaC and FiLaC combined with an advancement flap. Main outcome measures included operation duration, hospital stay, postoperative pain (VAS score), complications, and success rate Results: A total of 47 patients were included in the study, with 25 in the standard FiLaC group and 22 in the +FLAP group. The +FLAP group had significantly longer operation times (29.7 ± 4.7 minutes vs. 18.7 ± 4.0 minutes, p < 0.001) and hospital stays (16.2 ± 5.04 hours vs. 3.9 ± 2.3 hours p < 0.001). Postoperative pain scores were similar between groups. The mean follow-up periods for the FILAC and +FLAP groups were 10.5±3.5 months and 8.4±4.0 months, respectively. The success rate was significantly higher in the +FLAP group (95.5% vs. 72%, p = 0.03). Conclusion: Combining FiLaC with an advancement flap significantly improves primary success rates in the treatment of complex anal fistulas, despite longer operation and hospital stay times. This combined approach should be considered to enhance clinical outcomes for patients with complex anal fistulas.