Open Fistulectomy vs. Laser Closure for Low Perianal Fistula

Perianal fistula is an abnormal tunnel connecting the anal canal to the perianal skin,frequently causing chronic pain, discharge, and impaired quality of life. Traditionalopen fistulectomy is an established treatment with high healing rates, but it leaves anopen wound that requires prolonged recovery and carries a risk of anal sphincter injury.Fistula‐tract Laser Closure (FiLaC) is a minimally invasive, sphincter‐preservingtechnique that uses laser thermal energy to close the tract from within while minimizingtissue trauma.This study is a prospective, randomized controlled trial designed to compare the efficacyand safety of open fistulectomy versus laser fistulotomy in adult patients with primarylow perianal fistula.Participants are randomly assigned to one of two surgical treatment groups: ‐ Group 1: Laser fistulotomy (FiLaC) using a 1470 nm diode laser probe to seal thetract, combined with internal opening closure. ‐ Group 2: Conventional open fistulectomy involving complete excision of the fistulatract, allowing the wound to heal by secondary intention.Patients are evaluated during surgery and followed postoperatively at 24 hours, 48 hours,1 week, 2 weeks, 4 weeks, 3 months, and 6 months. The primary goals are to assess fistulahealing rates and postoperative pain levels. Secondary goals include evaluating operativetime, intraoperative blood loss, wound healing duration, complication rates, time toreturn to daily activities, fecal continence (measured by the Wexner Continence Score),and quality of life.