Increasing occurrences and recurrences of fistula conditions have led to devising new clinical treatments and procedures to resolve them. But surgical treatment is undoubtedly the most preferred way to treat them. And to prevent their recurrence, it is necessary to choose the right surgeon and the right procedure surgery.

In complex fistula surgery surgeon has to balance between successful surgical outcomes without any incontinence. LASER LIFT is a new surgical technique developed by Dr. SamratJankar, who is an eminent surgical gastroenterologist, a colorectal surgeon and a well-known laparoscopic surgeon in Pune. Symbiosis University Hospital Pune has developed an improvised LIFT procedure using LASER energy to offer a better healing experience.

In a recently held Continuing Medical Education session on LASER in Clinical Surgery at Dr. VithalraoVikhePatil Foundation’s Medical College & Hospital, Ahmednagar, on Friday, 19th March 2021, Dr. Samrat Jankar was a keynote speaker. He shared his expertise and experience in current concepts in complex fistula in ano management. He also conducted a live demonstration on LASER LIFT technique.

What is a complex anal fistula?

A complex anal fistula (Fistula in ano / Bhagandar) is a small tunnel that tracks from an opening inside the anal canal to an outside opening in the skin near the anus over the buttocks. An anal fistula often results from a previous or current anal abscess.

Causes of fistula in ano

Small glands just inside the anus are part of normal anatomy. If the glands in the anus become clogged due to constipation, local trauma, poor perianal hygiene, this may result in an infection. When the infection is severe, this often leads to an abscess. Subsequently, this abscess turns into fistula in ano. Crohn’s disease, cancer, trauma, and radiation are also known other causes of fistula in ano.

The LIFT procedure is one of the most preferred procedures done to treat fistula in ano conditions. This procedure involves dividing the fistula tract in the space between the internal and external sphincter muscles. This procedure avoids division of the sphincter muscle so there is zero percent risk of incontinence.

What led to Dr. Samratjankar develop a LASER LIFT as modification of LIFT procedure?

The success rate of a LIFT procedure is approximately 70 to 80%. As compared with all sphincter involving procedures, the LIFT is the best. Still, there are high chances of recurrence of anorectal fistula. As against this, the abovementioned LASER LIFT procedure is amodification of the LIFT procedure with promising results and high success rates.

Dr. Samrat states, ‘The LASER LIFT procedure begins with identifying the tract by dissection between sphincters then ligation and division of tract done as per standard LIFT surgical principles. The distal tract lining will be completely ablated circumferentially using radially emitting fibre of the laser energy which will help to faster healing. The LASER LIFT technique is a fusion of benefits of LASER and LIFT procedure which helps to reduce the recurrence of fistula without any risk of incontinence.

He proceeds to enumerate the multiple advantages of the LASER LIFT procedure, including a brief surgical procedure of just 30 – 40 minutes and discharge on the same day from the hospital. It is a quick and painless treatment without any risk of incontinence with very good success rate. The patient can resume normal activities within a day.

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