BACKGROUND: Lasers are used to treat various types of diseases, including fistula-in-ano. Until recently, the lasers used for this procedure radiated linear energy. OBJECTIVE: To assess the short-term outcomes of patients undergoing ablation of fistula in-ano tract using a new laser that radiates circumferential energy. DESIGN & SETTING: This study was approved by the local ethics committee at our institution. A 15-watt laser probe emitting at a wavelength of 1470 nm and producing 100–120 joules/cm of energy, was applied to 50 patients with fistula-in-ano under general anesthesia. Short-term outcomes, including success rate, complications, pain scores and time to return to normal daily activities, were evaluated. Success was defined as cessation of either the discharge or the patient’s complaints. RESULTS: Thirty-seven male and 13 female patients with a median age of 41 years (range: 23–83 years) were treated on an outpatient basis. Among these patients, 10 had inter-sphincteric fistulas, 34 had low transsphinteric fistulas and 6 had high transsphinteric fistulas. None of the patients required parenteral analgesics. The return to daily activities required a median of 7 days (range: 5–17 days). The median follow-up period was 12 months (range: 2–18 months). The success rate was 82%. Patients for whom the laser treatment was unsuccessful were later treated using traditional surgical methods. LIMITATIONS: The retrospective review of the data and the fact that substantial follow-up was done by phone and not through physical examination are the main limiting factors in this study. CONCLUSION: Laser ablation of fistula tract is a safe, effective, sphincter-preserving therapy that can be successfully performed by surgeons.

Purpose: To evaluate whether subcutaneous closed-suction drainage (SCSD) would decrease the SSI rate in elective abdominal operations. Methods: Participants were randomly assigned to have subcutaneous drains or not following elective abdominal surgery. The fascia and incision closure technique and antimicrobial prophylaxis were standardised. In the drain cohort, SCSD was applied after fascia closure. The drain was removed on postoperative day three. Patient characteristics, body mass index (BMI) and the depth of subcutaneous fatty tissue (SCFT) were noted. The incisional SSI rates were analysed. Results: There were 210 patients in the drain group and 192 in the no-drain group. There was no significant difference between groups in terms of demographics, BMI or SCFTs. The overall SSI rate was 7.7% and was 5.7% in the drain group and 9.9% in the no-drain group (p = 0.116). Neither BMI nor subcutaneous skin depth affected the SSI rate. However, subgroup analysis revealed that the SSI rate was lower in patients with drains who had undergone resection of colorectal malignancies or had lower abdominal incisions ( p< 0.03). Conclusions: The overall incisional SSI rate was comparable between the drain and no-drain groups. However, subcutaneous closed-suction drainage was not found effective in preventing SSI in our study except in a subgroup of patients with colorectal malignancies and lower abdominal incisions.