filac - dr. paolo giamundo, dept. of general surgery– hospital s. spirito, bra (cn)
DESCRIPTION
La presentació amb anglès del Dr. Paolo Giamundo, director of Colorectal Surgery Program at ASL CN Alba-Bra i Medical Manager in the Department of General Surgery at Hospital S. Spirito (Itàlia) tracta en concret una de les tecnologies làser en proctologia: FILACTRANSCRIPT
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Treatment of anal fistulas with laser: theory and results
“ FiLaC ”Paolo Giamundo
MD, FEBSQ Coloproctology
Dept. Of General Surgery– Hospital S. Spirito, Bra (CN) Director SOS Colonproctologia
ASL CN2 – Region Piemonte – [email protected]
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FiLaC (Fistula Laser Closure)
Diode Laser, 1470 nm
Radial Fiber: acting at 360°
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PhotoThermal effect< 45°C reversible hyperthermia45° – 63°C irreversible hyperthermia63° - 85°C Coartation, shrinkage,
denaturation85°-100°C Vaporization> 100°C Burning, Ablation
Effects of laser radiation on Human tissues
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Total shrinkage of anal fistula around the radial fiber
Diode Laser 1470 nm
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Fistula Laser Closure (FiLaC)
Technical notes:
-No mucosal flaps to close the internal orifice
-Local or Epidural anesthesia
-Potential benefit by placing a draining seton in the fistula tract approximately 8 weeks before the FiLaC:
- closure of small secondary tracts?,- new epithelium and fibrosis in the fistula?- making the caliber of the fistula homogeneous?
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Closure of Fistula-in-ano with laser: a viable option for the treatment of
recurrent anal fistulas
P. Giamundo MD, FEBSQ Coloproctology
Dept. of General Surgery (Dir: M. Valente) – Hospital S. Spirito –
Bra (CN) – ASL CN2 – Region Piemont, ITALY
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Fistula Laser Closure (FiLaC):Patient and fistulas characteristics
Patients 45 (24 F, 21 M)
AGE: 46 yo (RANGE 18-78)
TYPE OF FISTULA: - Intersphincteric 7 (15%)
- Low tra ns-sphincteric 7 (15%)- Mid trans-sphincteric 19 (42%)- High trans-sphincteric 10 (22%)- Supra-sphincteric 2 (4%)
PREVIOUS LOOSE SETON: 24 patients (53%)
PREVIOUS FISTULA SURGERY: 35 patients (78%)
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Fistula Laser Closure (FiLaC):
RESULTS (45 Patients)
MEAN OPERATIVE TIME (min.)20 (range 6-35)
MORBIDITY: - TEMPORARY TENESMUS (1 WEEK): 8 (18%) - URINARY RETENTION: 1 (
2%)- PAIN/ANISMUS ( 1 WEEK): 8 ( 18%)
- MODERATE BLEEDING 3 (6%)
MEDIAN HEALING TIME: 5 weeks ( range, 3-8)
FISTULAS CURED: 32 (71.1%)
MEDIAN FOLLOW-UP (months): 26 (range, 6-40)MEDIAN FOLLOW-UP (months): 26 (range, 6-40)
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Kaplan-Meier: Freedom from failure or
recurrence
Kaplan-Meier: Freedom from failure or
recurrence
At 1 year the freedom from failure or recurrence was 79%(previous seton) and
62% (no seton). These rates did not change at longer follow-up
At 1 year the freedom from failure or recurrence was 79%(previous seton) and
62% (no seton). These rates did not change at longer follow-up
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Fistula Laser Closure (FiLaC)CONCLUSIONSCONCLUSIONS 1
ADVANTAGES :
- SPHINCTER-SAVING
- EASY TO LEARN AND TO PERFORM
- REPEATABLE
- MINIMALLY-INVASIVE
- LOW MORBIDITY (no incontinence!)- HIGH PATIENTS’ COMPLIANCE
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- Indicated IN: High FistulasRecurrent FistulasPatients with Low Resting anal toneMultiparous womenCrohn’s disease
- In complex fistulas with potential presence of abscesses and/orsecondary tracts, FiLaC should be performed as a second stage operation after the placement of a draining seton
Fistula Laser Closure (FiLaC)CONCLUSIONSCONCLUSIONS 2
“FiLaC” (Fistula Laser Closure) Can be considered as another viable‘surgical option’in the
treatment of selected patients with anal fistulas