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DISTAL LASER PROXIMAL LIGATION (DLPL) TREATMENT FOR COMPLEX FISTULA


Jyoti Nursing Home in Jaipur provides the latest Distal Laser Proximal Ligation (DLPL) is a novel sphincter‐saving procedure for the treatment of complex anal fistula. Primary closure of the track is achieved using laser energy emitted by a radial fibre connected to a diode laser. The energy causes shrinkage of the tissue around the radial fibre with the aim being to close the track. This pilot study was designed to investigate the safety and effectiveness of this new technique in the treatment of complex anal fistula. The aim is to gently remove the complex fistula tract without damaging the sphincter. Thus, any parts of the muscle are preserved to a maximum and incontinence is avoided. In order to eliminate the complex fistula tract as gently as possible, the flexible, radially emitting laser fiber is inserted from the outside and positioned exactly by using the pilot beam. Defined energy is being emitted radially into the fistula. The epithet lialized tissue is being destroyed in a controlled way and the complex fistula tract collapses to a very high degree. This also supports and accelerates the healing process.

The surgical technique adapted depends first of all on the route of the complex fistula. The (complex fistula) tract can either run under mucous membrane (by-passing the sphincter muscle) or break through the sphincter muscle partly or completely. Usually, surgery takes place under spinal cord anesthesia or general anesthesia.

Distal Laser Proximal Ligation (DLPL) Treatment For fistula in Jaipur

During laser therapy, defined energy will be led into the fistula tract with help of an innovative laser probe. By this, the fistula tissue will be destroyed in a most sparing way and has not to be tediously extracted during a complex surgery by a surgeon. The laser probe is slowly pulled back step by step like a zipper, and the fistula is being closed. The highly flexible probe is suitable for the application even in wound tracts and can be applied independently from the length of the fistula tract. The laser treatment takes only a few minutes and provides the possibility to completely spare the enucleation of the fistula out of the healthy tissue.

After insertion of the laser probe into the fistula tract, the laser destroys the fistula tissue and closes the tract. The treatment is virtually painless, and the period of recovery is tangibly shorter than for conventional surgical methods.

The latest Distal Laser Proximal Ligation (DLPL) procedure for complex fistula-in-ano is a safe, relatively simple, minimally invasive, sphincter-saving procedure with a high chance of success. The laser Distal Laser Proximal Ligation (DLPL) applies energy to the pathway of the fistula tract. The 360° energy emission ensures homogenous photothermal destruction of the complex fistula tract, allowing safe closure. Any flap techniques can be performed before or after the laser application. The efficient radiation concept of the laser Distal Laser Proximal Ligation (DLPL) fiber makes optimal use of the laser energy applied. Optimal monitoring of the fiber tip is possible thanks to its excellent ultrasound visibility (if applied)

Our Patient had either a primary or a recurrent trans‐sphincteric Complex Anal fistula, a previously placed seton or a fistula involving a significant portion of the sphincter with a potential risk of postoperative incontinence on fistulotomy. The surgical procedure consisted of ‘sealing’ the complex fistula by laser energy. The primary end‐point was cure of the disease and evaluation of morbidity.