Post-op Pain After Fistula Laser Closure or Ligation of the Intersphincteric Tract for Anal Fistula

Comparison of Post-operative Pain Between Fistula Laser Closure and Ligation of the Intersphincteric Tract in the Treatment of Anal Fistula - a Randomized Controlled Trial. (LASERLIFT)

This is a prospective, double-blinded randomised controlled trial conducted at two tertiary hospitals by a credentialed colorectal surgeon.

Patients with high transphincteric fistulas were blinded and randomized to either laser or ligation of the fistula tract (LIFT). Pain scores at rest and movement, at 6 and 24 hours post operatively were measured using the visual analogue scale (VAS). Operative time was measured in minutes Continence and quality of life was assessed via the Wexner incontinence scale and SF-36 questionnaire respectively at 0, 3 and 6 months post-operatively.

Inclusion Criteria:

• Complex transphincteric fistulas:
• high transphincteric fistula, involving more than 30% of the external anal sphincter
• Multiple fistulas
• Anterior fistulas
• 18-75 years old
• Able to give consent
• New or recurrent fistulas
• Fistulas with or without setons

Exclusion Criteria:

• Active perianal sepsis requiring drainage
• Fistulas of non-cryptogladular origin- Crohn's, TB, malignancy
• Expected lifespan less than 6 months
• Pregnant women
• Patients with more than 1 definitive surgery done for the fistula before
• Patients with human immunodeficiency virus infection
• Patients with pre-existing chronic pain disorders
• Patients with Non-steroidal Anti-inflammatory Drug (NSAIDS) / Paracetamol allergies