{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:47:19Z","timestamp":1789469239892,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T00:00:00Z","timestamp":1717632000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient\u2010reported outcomes, such as postoperative pain, which could influence surgical choice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare pain scores at 6 and 24\u00a0h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective, double\u2010blinded randomized controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>A quaternary hospital in Malaysia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Patients aged 18\u201375\u00a0years with high transsphincteric fistulas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Fistula laser closure versus ligation of the fistula tract (LIFT) treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Pain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi\u2010square, Fisher's exact test, student <jats:italic>t<\/jats:italic>\u2010test, or Mann\u2013Whitney with <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05 denoting statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010six patients were recruited (laser, <jats:italic>n<\/jats:italic>\u00a0=\u00a028, LIFT, <jats:italic>n<\/jats:italic>\u00a0=\u00a028). Median pain scores for laser versus LIFT at 6\u00a0h postoperatively were 1.0 versus 2.0 (Rest, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.213) and 3.0 versus 4.0 (Movement, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.448), respectively. At 24\u00a0h, this reduced to 2.5 in both arms at rest (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.842) but increased to 4.8 versus 3.5 on movement (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.383). Median operative time for laser was significantly shorter (32.5\u00a0min) than LIFT (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.181) but treatment failure was similar (54% vs. 50%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.71). No patients developed postoperative incontinence. Mean SF\u201036 scores increased from baseline (67.1\u00a0\u00b1\u00a017.0; 95% CI 63.6\u201382.4 vs. 71.3\u00a0\u00b1\u00a011.4; 95% CI 64.0\u201375.0) to 6\u00a0months postoperatively (77.7\u00a0\u00b1\u00a021.0; 95% CI 57.0\u201380.3 vs. 74.0\u00a0\u00b1\u00a014.3; 95% CI 67.6\u201381.4) regardless of the type of surgery (<jats:italic>P<\/jats:italic>\u00a0&gt;\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Patients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Laser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov: NCT06212739.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12242","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T01:38:05Z","timestamp":1717724285000},"page":"1990-1999","source":"Crossref","is-referenced-by-count":5,"title":["Postoperative pain following laser fistula closure versus ligation of the intersphincteric fistula tract: A prospective double\u2010blinded randomized controlled trial"],"prefix":"10.1002","volume":"48","author":[{"given":"Jolynn Qian Lin","family":"Low","sequence":"first","affiliation":[{"name":"Department of Surgery Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5247-2817","authenticated-orcid":false,"given":"Retnagowri","family":"Rajandram","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Rezal Abdul","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2458-965X","authenticated-orcid":false,"given":"April Camilla","family":"Roslani","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,6]]},"reference":[{"key":"e_1_2_14_2_1","first-page":"1","volume-title":"Corman's colon and rectal surgery","author":"Corman M. 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