Evidence map›Paper›PMID 40936062›Full record

SynthesisInternational journal of colorectal disease2025

Effectiveness of Laser-Based Fistula Therapies with and without Adjunctive Measures in Anal Fistulas Management: A Systematic Review and Single-Arm Meta-Analysis.

Joao Ricardo Duda, Luiz Gustavo Albuquerque Mello de Oliveira, Luiza Fenelon Ferreira, Beanie Conceição Medeiros Nunes, Murilo Cavalcante Netto do Carmo, Diogo Bergesch Diedrich, Matheus Cavalcante Franco, Marcelo Cristalli Pacheco da Costa, Stefano Baraldo

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal of colorectal disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Observational
  4. Article
  5. Core-Out Fistulectomy Combined With Laser Ablation of the Trans-Sphincteric Fistula Tract: A Pilot Study of Efficacy and Safety.Medical science monitor : international medical journal of experimental and clinical research · 2026
    Article
  6. Article
  7. Ligation of the intersphincteric fistula tractWorld journal of gastrointestinal surgery · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Joao Ricardo DudaEndoskope - Endoscopic Diagnostics Clinic, Curitiba, Paraná, Brazil. joaorduda@gmail.com.
Luiz Gustavo Albuquerque Mello de OliveiraFederal University of Bahia (Salvador, BA), Bahia, Salvador, Brazil.
Luiza Fenelon FerreiraUniversity Hospital of the University of São Paulo, São Paulo, Brazil.
Beanie Conceição Medeiros NunesHospital of Clinics of the University of São Paulo, São Paulo, Brazil.
Murilo Cavalcante Netto do CarmoFederal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Diogo Bergesch DiedrichFederal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Matheus Cavalcante FrancoUT Health San Antonio, San Antonio, TX, USA.
Marcelo Cristalli Pacheco da CostaDepartment of Endoscopy, Unimed Sorocaba, Sorocaba, Brazil.
Stefano BaraldoInstitute for Teaching and Research, Barretos Cancer Hospital, Barretos, SP, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeFistula Laser Closure (FiLaC®) is a sphincter-preserving technique for anal fistulas, but its efficacy and safety remain under discussion. Therefore, we aim to evaluate the efficacy and safety of FiLaC® in the management of patients with cryptoglandular fistulas.

methodsA systematic review was performed in MEDLINE, Embase, and Cochrane databases in January 2025, following PRISMA guidelines. We included randomized controlled trials (RCTs) and observational studies assessing FiLaC® for cryptoglandular fistulas, with or without surgical adjunctive measures. The main outcome was the primary healing rate. Secondary outcomes included fistula recurrence, incontinence, reoperation rates, and postoperative complications. Subgroup analyses explored variables related to the primary healing rate. Data are presented as percentages (95% confidence interval). Statistical analyses were performed using R (version 4.4.1 (2024-06-14 (ucrt)).

resultsWe included 24 studies with 1,503 patients. The pooled primary healing rate was 57.46% (49.40-65.33). Recurrence occurred in 18.48% of patients (10.14-28.47), while new-onset incontinence was rare (0.57%; 0.00-2.15). The reoperation rate was 36.49% (28.95-44.36), and anal abscesses or infections affected 6.54% (1.93-13.09) of patients. Subgroup analysis showed no statistically significant differences in the primary healing rate based on fistula type, adjunctive measures, or sex. Sensitivity analysis confirmed the robustness of our findings.

conclusionsFiLaC® seems to be a safe option with an intermediate healing rate in patients with cryptoglandular fistulas, although it is associated with a considerable recurrence rate. While its sphincter preservation advantage is evident, further RCTs standardizing the technique and adjunctive approaches are needed to optimize outcomes and refine its application in fistula management.

Indexed as

Laser TherapyRectal FistulaHumansMalePostoperative ComplicationsRecurrenceTreatment OutcomeCryptoglandular fistulasFiLaCHealing rateMeta-analysisRectal fistula

Identifiers

PMID40936062
PMCPMC12426143

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.