Efficacy of FiLaC in different types of anal fistula. A systematic review and meta-analysis

Fistula Tract Laser Closure (FiLaC) represents a minimally invasive technique for the management of fistula in ano. However, no data exists on the success rates of FiLaC for the different fistula types. This systematic analysis and meta-analysis were performed following the PICOS and PRISMA guidelines. A systematic literature review was conducted for articles published in Web of Science, Embase, Cochrane Library, PubMed using search terms 'Anal fistula OR fistula in ano OR anorectal fistula' (Mesh term), 'Laser', 'Park´s classification, 'complex fistula (Mesh term), and 'Clinical Trial' (Mesh term), 'healing rate', and 'closure rate' from inception until February 2025. Pooled results for 16 studies indicated higher healing rates for simple fistula (60.8%) compared to complex fistula (54.6%). Amongst complex fistulae, transsphincteric fistulae have the best odds of healing following FiLaC. The success rate of FiLaC for extrasphincteric and suprasphincteric fistulae is about 50%. Amongst all fistula types, although not statistically significant simple fistulae have a higher odds of healing following FiLaC in comparison to complex fistulae. Amongst complex fistulae, transsphincteric fistulae have the best success rates following FiLaC. Extrasphincteric and suprasphincteric fistulae have about 50% success rate following FiLaC.