QS110 - Contra-incision Combined With Fistula-tract Laser Closurein In Complex Anal Fistulas Management: A Prospective,Single-centre, Open-label, Randomised Clinical Trial

Sunday, May 11, 2025

9:16 AM – 9:19 AM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

Zehui Wang

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

HX

Hao Xu, n/a

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

Disclosure information not submitted.
TC

Tian Chen, n/a

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

Disclosure information not submitted.
SL

Suzhi Liu, n/a

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

Disclosure information not submitted.
SZ

Songlin Zhang, n/a

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

Disclosure information not submitted.
MY

Min Yuan, n/a

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

Disclosure information not submitted.

Senior Author(s)

WY

Wei Yang, n/a

528 Zhangheng Road, Shanghai 201203, China
Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
Shanghai, Shanghai, China (People's Republic)

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Zehui Wang: This individual has no financial relationships with ineligible companies.

Wei Yang, n/a: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The treatment of complex anal fistulas (CAF) presents a significant challenge. Inaccurate diagnosis and improper treatment can severely compromise anal function and morphology, potentially leading to complications such as anal incontinence, displacement, and tissue defects in the anal canal. Moreover, the treatment process is often prolonged and has a high recurrence rate, resulting in considerable physical and psychological distress for patients, as well as imposing a substantial socio-economic burden. The Contra-incision Combined with Fistula-tract Laser Closure (CFLC) procedure is a novel and effective surgical technique that promotes smoother postoperative drainage, thereby shortening the healing time. This study aims to evaluate the efficacy and safety of this procedure.

Methods/Interventions: This prospective, single-centre, open-label, randomized controlled trial enrolled patients with fistulas involving more than one-third of the sphincter complex and associated secondary tracts. Patients were randomly assigned (1:1) to undergo either the Contra-incision Combined with Fistula-tract Laser Closure (CFLC) procedure or the conventional cutting seton (CS) procedure, with 48 patients in each group. The follow-up period was six months, and the primary outcome measure was the time to complete fistula healing. Secondary outcome measures included the Wexner score, maximum anal sphincter pressure, and QoLAF-Q score at six months postoperatively.

Results/Outcomes: A total of 96 patients with high-level complex anal fistulas were included in this study. In the CFLC procedure group, the mean age was 43 years (range 19–64), with 38 patients (79.2%) being male. Based on the Parks classification, there were 22 cases (45.8%) of intersphincteric fistulas, 15 cases (31.3%) of transsphincteric fistulas, 9 cases (18.8%) of suprasphincteric fistulas, and 2 cases (4.2%) of extrasphincteric fistulas. In the CS procedure group, the mean age was 44 years (range 18–63), with 30 patients (62.5%) being male. According to the Parks classification, there were 25 cases (52.1%) of intersphincteric fistulas, 15 cases (31.3%) of transsphincteric fistulas, 6 cases (12.5%) of suprasphincteric fistulas, and 2 cases (4.2%) of extrasphincteric fistulas. The healing time in the CFLC group was significantly shorter than that in the CS group (53.8 ± 12.3 days vs. 60.3 ± 18.2 days, p = 0.04). At six months postoperatively, the Wexner score was significantly lower in the CFLC group compared to the CS group (0 [IQR 0,1] vs. 5 [IQR 4,7], p < 0.001), while the maximum anal sphincter pressure was significantly higher in the CFLC group (155.9 mmHg [IQR 137.9,160.6] vs. 141.5 mmHg [IQR 135.7,152.5], p = 0.001). Additionally, the QoLAF-Q score was significantly lower in the CFLC group than in the CS group (21.0 [IQR 20.0,25.5] vs. 23.5 [IQR 20.0,28.5], p = 0.02).

Conclusion/Discussion: CFLC is a safe and effective surgical approach for the treatment of high-level complex anal fistulas. Compared to the CS procedure, it significantly shortens the wound healing time and greatly reduces the risk of anal incontinence, thereby improving the postoperative quality of life for patients.