{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T16:24:54Z","timestamp":1775319894549,"version":"3.50.1"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007195","name":"Universit\u00e0 degli Studi di Napoli Federico II","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007195","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Tech Coloproctol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complex perianal fistulas present a significant surgical challenge due to high recurrence rates and the need to preserve sphincter function. Fistula-tract Laser Closure (FiLaC\u2122) is a minimally invasive technique that offers promising results, but incomplete closure of the internal opening remains a major cause of recurrence. To improve outcomes, we propose the FiLaFlap technique, which combines FiLaC\u2122 with a mucosal advancement flap to enhance fistula healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of patients who underwent seton removal with the FiLaFlap procedure between January 2023 and September 2024. Postoperative data, including pain levels, complications, continence status, and follow-up outcomes, were collected prospectively. Patients underwent clinical evaluations and 3D endoanal ultrasound assessments at predefined intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 24 patients (58.3% male, mean age 39.4\u2009\u00b1\u200912.4\u00a0years) were included. The mean time between seton placement and FiLaFlap was 5.95\u2009\u00b1\u20091.78\u00a0months. Postoperative pain was low (VAS 2.20\u2009\u00b1\u20090.97), and no major complications occurred. At 6\u00a0months, 91.6% of patients achieved clinical remission, while 83.3% had ultrasound-confirmed healing. Only one patient reported minor incontinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The FiLaFlap technique appears to be a safe and potentially effective sphincter-preserving strategy for complex perianal fistulas, demonstrating high remission rates with minimal morbidity. Further studies with larger cohorts and extended follow-up are needed to validate these preliminary findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10151-025-03271-8","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T08:05:42Z","timestamp":1766563542000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A novel sphincter-sparing procedure for seton removal in complex perianal fistulas: the FiLaFlap technique"],"prefix":"10.1007","volume":"30","author":[{"given":"M.","family":"Cricr\u00ec","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Miele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F. P.","family":"Tropeano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Zoretti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. D.","family":"De Palma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5931-9599","authenticated-orcid":false,"given":"G.","family":"Luglio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"issue":"1","key":"3271_CR1","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12893-023-01912-z","volume":"23","author":"D Garc\u00eda-Olmo","year":"2023","unstructured":"Garc\u00eda-Olmo D, G\u00f3mez-Barrera M, de la Portilla F (2023) Surgical management of complex perianal fistula revisited in a systematic review: a critical view of available scientific evidence. BMC Surg 23(1):29","journal-title":"BMC Surg"},{"key":"3271_CR2","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1097\/DCR.0000000000000733","volume":"59","author":"JD Vogel","year":"2016","unstructured":"Vogel JD, Johnson EK, Morris AM et al (2016) Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum 59:1117\u20131133","journal-title":"Dis Colon Rectum"},{"key":"3271_CR3","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s10151-022-02682-1","volume":"26","author":"D Cao","year":"2022","unstructured":"Cao D, Li W, Ji Y, Wang X, Cui Z (2022) Efficacy and safety of FiLaC\u2122 for perianal fistulizing Crohn\u2019s disease: a systematic review and meta-analysis. Tech Coloproctol 26:775\u2013781","journal-title":"Tech Coloproctol"},{"key":"3271_CR4","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/s10151-020-02165-1","volume":"24","author":"H Elfeki","year":"2020","unstructured":"Elfeki H, Shalaby M, Emile SH, Sakr A, Mikael M, Lundby L (2020) A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol 24:265\u2013274","journal-title":"Tech Coloproctol"},{"key":"3271_CR5","doi-asserted-by":"publisher","first-page":"467","DOI":"10.2147\/CEG.S269464","volume":"14","author":"SO Adegbola","year":"2021","unstructured":"Adegbola SO, Sahnan K, Tozer P, Warusavitarne J (2021) Emerging data on fistula laser closure (FiLaC) for the treatment of perianal fistulas; patient selection and outcomes. Clin Exp Gastroenterol 14:467\u2013475","journal-title":"Clin Exp Gastroenterol"},{"key":"3271_CR6","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s10151-017-1699-4","volume":"21","author":"SO Adegbola","year":"2017","unstructured":"Adegbola SO, Sahnan K, Pellino G et al (2017) Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol 21:775\u2013782","journal-title":"Tech Coloproctol"},{"issue":"5","key":"3271_CR7","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1097\/DCR.0000000000001038","volume":"61","author":"MC Terzi","year":"2018","unstructured":"Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F (2018) Closing perianal fistulas using a laser: long-term results in 103 patients. Dis Colon Rectum 61(5):599\u2013603","journal-title":"Dis Colon Rectum"},{"issue":"9","key":"3271_CR8","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s10151-019-02070-2","volume":"23","author":"N De Hous","year":"2019","unstructured":"De Hous N, de Gheldere C, Van den Broeck S, Komen N (2019) FiLaC\u2122 as a last, sphincter-preserving resort for complex perianal fistula. Tech Coloproctol 23(9):937\u2013938","journal-title":"Tech Coloproctol"},{"key":"3271_CR9","doi-asserted-by":"crossref","unstructured":"Serin KR, Hac\u0131m NA, Karabay O, Terzi MC (2020) Retrospective analysis of primary suturing of the internal orifice of perianal fistula during FiLaC procedure. Surg Laparosc Endosc Percutan Tech 30(3):266\u20139","DOI":"10.1097\/SLE.0000000000000774"},{"issue":"2","key":"3271_CR10","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s10151-020-02332-4","volume":"25","author":"A Wolicki","year":"2021","unstructured":"Wolicki A, J\u00e4ger P, Deska T, Senkal M (2021) Sphincter-saving therapy for fistula-in-ano: long-term follow-up after FiLaC\u00ae. Tech Coloproctol 25(2):177\u2013184","journal-title":"Tech Coloproctol"},{"issue":"1","key":"3271_CR11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s10151-024-03038-7","volume":"29","author":"H Uzun","year":"2025","unstructured":"Uzun H, Kara YB, Eser M, Kaptano\u011flu L, Kement M (2025) Comparative outcomes of standard laser fistula closure (filac) versus filac combined with advancement flap in the treatment of complex anal fistulas. Tech Coloproctol 29(1):7","journal-title":"Tech Coloproctol"},{"issue":"4","key":"3271_CR12","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s10151-017-1599-7","volume":"21","author":"A Wilhelm","year":"2017","unstructured":"Wilhelm A, Fiebig A, Krawczak M (2017) Five years of experience with the FiLaC\u2122 laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol 21(4):269\u2013276","journal-title":"Tech Coloproctol"},{"issue":"2","key":"3271_CR13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1007\/s13244-010-0022-y","volume":"1","author":"MR Torkzad","year":"2010","unstructured":"Torkzad MR, Karlbom U (2010) MRI for assessment of anal fistula. Insights Imaging 1(2):62\u201371","journal-title":"Insights Imaging"},{"issue":"3","key":"3271_CR14","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1148\/radiol.2333031724","volume":"233","author":"GN Buchanan","year":"2004","unstructured":"Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CRG (2004) Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 233(3):674\u2013681","journal-title":"Radiology"},{"key":"3271_CR15","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1097\/DCR.0b013e318249d26c","volume":"55","author":"MRS Siddiqui","year":"2012","unstructured":"Siddiqui MRS, Ashrafian H, Tozer P et al (2012) A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 55:576\u2013585","journal-title":"Dis Colon Rectum"},{"issue":"8","key":"3271_CR16","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1097\/DCR.0000000000001099","volume":"61","author":"G Luglio","year":"2018","unstructured":"Luglio G, Giglio MC, Rispo A et al (2018) Diagnostic accuracy of 3-dimensional endoanal ultrasound in identifying perianal Crohn\u2019s fistulas. Dis Colon Rectum 61(8):931\u2013937","journal-title":"Dis Colon Rectum"}],"container-title":["Techniques in Coloproctology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10151-025-03271-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-025-03271-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-025-03271-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:04:04Z","timestamp":1769000644000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10151-025-03271-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["3271"],"URL":"https:\/\/doi.org\/10.1007\/s10151-025-03271-8","relation":{},"ISSN":["1123-6337","1128-045X"],"issn-type":[{"value":"1123-6337","type":"print"},{"value":"1128-045X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,24]]},"assertion":[{"value":"26 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by Local Ethics Committee, and all patients provided written informed consent for surgery and for the use of anonymized data for research purposes.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical and informed consent"}}],"article-number":"25"}}