Comparison of outcome in Hybrid Laser Surgery (DLPL) and Partial Fistulectomy with Seton in Complex Fistula-in-Ano: A randomized controlled trial.

Abstract

Objective: To compare the clinical outcomes of DLPL with partial fistulectomy combined with seton placement in patients with complex fistula-in-ano. Study Design: Randomized Controlled Trial. Setting: Aziz Fatimah Hospital which is Affiliated with Aziz Fatimah Medical and Dental College, Faisalabad. Period: One Year from January 2025 to January 2026. Methods: We enrolled 52 patients with complex fistula-in-ano. Patients were randomly allocated to either DLPL (n=26) or partial fistulectomy with seton placement (n=26). Inclusion criteria comprised recurrent fistulas, multiple external openings, and high-lying fistulas confirmed by MRI. Primary outcomes included healing rate, recurrence rate, healing duration, and incontinence. Secondary outcomes included return to work time and treatment cost. Follow-up assessments were conducted at 1, 3, 6, and 12 months postoperatively. Results: Of 52 enrolled patients, 42 completed the study (21 per group). The DLPL group demonstrated superior outcomes with an 85.7% healing rate compared to 62% in the fistulectomy group. Mean healing time was significantly shorter in the DLPL group (4±1.5 weeks vs. 11±2.3 weeks). Recurrence occurred in 3 patients (14.3%) in the DLPL group versus 8 patients (38%) in the fistulectomy group. Notably, no incontinence was observed in the DLPL group, while 17 patients (81%) in the fistulectomy group developed incontinence. Return to work was significantly faster with DLPL (14±4 days vs. 45±5 days). Treatment costs were comparable between groups (0.15 vs. 0.14 million rupees). Conclusion: Hybrid laser surgery (DLPL) represents a superior treatment modality for complex fistula-in-ano, offering significantly better healing rates, faster recovery, lower recurrence, and complete preservation of continence compared to partial fistulectomy with seton placement. Despite comparable costs, DLPL should be considered the preferred approach for complex anal fistulas in appropriate clinical settings.