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Impact of Preoperative Bowel Preparation on Healing Outcomes in FiLaC
Sponsor: Acibadem Kent Hospital
Summary
Background: Fistula tract laser closure (FiLaC) has emerged as a sphincter-preserving treatment for anal fistula (AF). However, the optimal role of preoperative bowel preparation (BP) in enhancing postoperative outcomes remains contentious. While some surgeons recommend enemas to empty the rectum, others ignore BP altogether due to concerns about possible contamination from enemas. Current guidelines suggest that the decision to perform BP is at the surgeon's discretion, as it is not definitively linked to healing rates. Objective: This prospective, non-randomized observational cohort study aims to evaluate whether preoperative bowel preparation significantly impacts primary healing rates following FiLaC in patients with anal fistula. Methods: One hundred consecutive patients undergoing FiLaC will be prospectively enrolled and stratified into two cohorts: Group A (BP) and Group B (no BP). Anal fistulas will be classified by Parks classification. The primary outcome is complete clinical healing at three months, defined by the absence of discharge, an epithelialized external opening, and no recurrence. Secondary outcomes include six-month healing rates, recurrence, postoperative pain, quality of life, Wexner continence scores, and complication rates. Multivariate logistic regression will be employed to control for potential confounders, including smoking status, prior seton use, and fistula complexity. Discussion: This study aims to fill the evidence gap regarding the benefits of preoperative BP in FiLaC procedures, improving perioperative protocols to optimize healing outcomes while reducing unnecessary interventions. The findings will provide clinicians with evidence-based guidance on BP strategies.
Official title: Impact of Preoperative Bowel Preparation on Healing Outcomes in Fistula Laser Closure: A Protocol for a Single Center, Non-Randomised Clinical Trial
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
OBSERVATIONAL
Enrollment
100
Start Date
2026-10-01
Completion Date
2027-12-01
Last Updated
2026-09-02
Healthy Volunteers
No
Interventions
Bowel preparation before fistula laser closure (FiLaC) surgery
Standardized bowel preparation will be administered to Group A patients. This involves a clear liquid diet the day prior to surgery. Polyethylene glycol (3 liters) will be initiated at 16:00 PM on the evening before the operation, consumed as 250 mL every 10 minutes, aiming for completion by 21:00 PM. Clear liquid intake is permitted until midnight. If there are particles in the stool on the morning of the operation, a rectal enema will be administered.