{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:54:46Z","timestamp":1786632886443,"version":"build-2736575974"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Fistula laser closure (FiLaC) is a\u00a0minimally invasive treatment option for perianal fistulas with acceptable healing rates. We report implementation and include short-term results in line with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study)\u00a02A framework in patients with complex fistulas and previous surgical repair attempts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Prospective audit data from 56\u00a0consecutive patients with perianal fistulas treated between June 2024 and January 2025. The FiLaC procedure included cleaning the fistula tract, application of approximately 100\u202fJ\/cm fistula length and closing of the internal opening with a\u00a0stitch. All patients refused more invasive operations and\/or were not suitable for advanced repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients were diagnosed with fistulas after a\u00a0median of 34.5 months (interquartile range, IQR 13.8\u201354.2 months), with a\u00a0median of 3 months (IQR 1.8\u20134.0 months) following previous fistula-related surgery. Most patients had cryptoglandular fistulas (80.4%) while 19.6% had inflammatory bowel disease-related fistulas. Most fistulas were transsphincteric (69.6%), and only 32.1% of patients were seton-free before the procedure. During the first postprocedural outpatient visit at 7.9\u00a0weeks (median; IQR 6.4\u201310.9 weeks), clinical healing was evident in 14 (24.1%) cases, and 23 (39.7%) patients reported relevant symptomatic improvement. A\u00a0total of 21\u00a0patients (36.2%) did not report any improvement, 3 patients (5.2%) experienced a\u00a0postoperative complication, with 1 (1.7%) requiring a\u00a0return to theatre due to an abscess. After a\u00a0median of 10.4 months, the \u201cseton-free rate\u201d was 67.9%, This represents a\u00a0relevant improvement to 32.1% before FiLaC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of FiLaC is a\u00a0safe, sphincter-preserving treatment for complex perianal fistulas and was associated with a\u00a0marked increase in the seton-free rate. While complete fistula healing rates were lower than previously reported, FiLaC remains an option for patients with complex disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00508-026-02797-7","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:26:30Z","timestamp":1786631190000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment of complex perianal fistulas with fistula laser closure"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2307-3088","authenticated-orcid":false,"given":"Matthew Joseph","family":"Marino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8664-2220","authenticated-orcid":false,"given":"Benjamin","family":"Dimbleby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-9204","authenticated-orcid":false,"given":"Lukas","family":"Schlager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0547-4178","authenticated-orcid":false,"given":"Patrick","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Roland Christopher","family":"James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2975-416X","authenticated-orcid":false,"given":"Simon","family":"Buczacki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8238-7779","authenticated-orcid":false,"given":"Helen","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8423-2268","authenticated-orcid":false,"given":"Lukas Walter","family":"Unger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"12","key":"2797_CR1","doi-asserted-by":"publisher","first-page":"3503","DOI":"10.1007\/s12325-019-01117-y","volume":"36","author":"D Garcia-Olmo","year":"2019","unstructured":"Garcia-Olmo\u00a0D, Van Assche\u00a0G, Tagarro\u00a0I, Diez\u00a0MC, Richard\u00a0MP, Khalid\u00a0JM, et\u00a0al. Prevalence of Anal Fistulas in Europe: Systematic Literature Reviews and Population-Based Database Analysis. Adv Ther. 2019;36(12):3503\u201318.","journal-title":"Adv Ther"},{"issue":"6","key":"2797_CR2","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s10151-017-1645-5","volume":"21","author":"J Sugrue","year":"2017","unstructured":"Sugrue\u00a0J, Nordenstam\u00a0J, Abcarian\u00a0H, Bartholomew\u00a0A, Schwartz\u00a0JL, Mellgren\u00a0A, et\u00a0al. Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review. Tech Coloproctol. 2017;21(6):425\u201332.","journal-title":"Tech Coloproctol"},{"issue":"6","key":"2797_CR3","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/S2468-1253(22)00007-3","volume":"7","author":"J Geldof","year":"2022","unstructured":"Geldof\u00a0J, Iqbal\u00a0N, LeBlanc\u00a0JF, Anandabaskaran\u00a0S, Sawyer\u00a0R, Buskens\u00a0C, et\u00a0al. Classifying perianal fistulising Crohn\u2019s disease: an expert consensus to guide decision-making in daily practice and clinical trials. Lancet Gastroenterol Hepatol. 2022;7(6):576\u201384.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"1","key":"2797_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/bjs.1800630102","volume":"63","author":"AG Parks","year":"1976","unstructured":"Parks\u00a0AG, Gordon\u00a0PH, Hardcastle\u00a0JD. A classification of fistula-in-ano. Br J Surg. 1976;63(1):1\u201312.","journal-title":"Br J Surg"},{"issue":"5","key":"2797_CR5","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/j.gastro.2003.08.025","volume":"125","author":"WJ Sandborn","year":"2003","unstructured":"Sandborn\u00a0WJ, Fazio\u00a0VW, Feagan\u00a0BG, Hanauer\u00a0SB, American Gastroenterological Association Clinical Practice C. AGA technical review on perianal Crohn\u2019s disease. 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Dis Colon Rectum. 2022;65(5):713\u201320.","journal-title":"Dis Colon Rectum"}],"container-title":["Wiener klinische Wochenschrift"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-026-02797-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00508-026-02797-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-026-02797-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:26:32Z","timestamp":1786631192000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00508-026-02797-7"}},"subtitle":["Application of the IDEAL\u00a02A framework"],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":24,"alternative-id":["2797"],"URL":"https:\/\/doi.org\/10.1007\/s00508-026-02797-7","relation":{},"ISSN":["0043-5325","1613-7671"],"issn-type":[{"value":"0043-5325","type":"print"},{"value":"1613-7671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"29 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was registered as prospective local audit (Ulysses audit #9310).","order":1,"name":"Ethics","label":"Ethics approval statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for patient consent was waived due to registration as clinical audit. All patients whose procedure was filmed gave specific consent and gave written informed consent for their videos to be used for educational and training purposes, including publication.","order":2,"name":"Ethics","label":"Patient consent statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Permission to reproduce materials from other sources","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was registered as prospective local audit (Ulysses audit #9310).","order":4,"name":"Ethics","label":"Clinical trial registration","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"L.W.\u00a0Unger has received travel grants from Intuitive Surgical, Inc, speaker fees from Merck and AbbVie, and has been awarded a\u00a0collaborative research grant from Boehringer Ingelheim unrelated to the manuscript. M.J.\u00a0Marino, B.\u00a0Dimbleby, L.\u00a0Schlager, P.\u00a0Campbell, D.R.C.\u00a0James, S.\u00a0Buczacki and H.\u00a0Jones declare that they have no competing interests.","order":5,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}