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Aim: Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC™) technique could achieve higher healing rates and a better functional outcome than RAF., Method: We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC™ with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively., Conclusion: High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC™ with the gold standard treatment with RAF. In case of noninferiority, FiLaC™ treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques., (© 2024 Association of Coloproctology of Great Britain and Ireland.)

Background: Fistula formation in hidradenitis suppurativa follows an uncontrolled infection with subcutaneous tracts leading to 'watering-can' or 'pus-pot' perineum. Closure of this type of fistula implies major surgery and is bound to fail in refractory inflammatory environment. Minimally invasive techniques have become the first line of choice in every type of surgery., Methods: Fistula-tract Laser Closure (FiLaC™, Biolitec, Germany) is a novel technique already reported to have been used in the treatment of fistula-in-ano and pilonidal sinus. It consists of blind cauterization and obliteration of the fistula tract from the inside by means of a radial-emitting laser probe. We present two patients who underwent surgery for urethroperineal fistula using this technique., Results: In both cases, the fistula tracts were completely closed after 3 months of follow-up. The wounds had healed smoothly and complete resolution of symptoms was noted., Conclusions: The use of FiLaC™ for the treatment of urethroperineal fistula is feasible and safe. The minimally invasive nature of the technique and limited postoperative pain permit daycare surgery.