VAAFT with laser vs LIFT for transsphincteric fistula

What is known

• A meta-analysis of 1378 LIFT procedures reported 76% success, 14% complications, and 1.4% fecal incontinence. ¹
• VAAFT (fistuloscope with closure of the internal opening) showed 1-year healing rates of 74–87%, though maximum follow-up was only 12 months. ¹
• FiLaC laser-closure series report modest healing, with one titled around '50% healing rates', and existing FiLaC data are single-center, retrospective, non-comparative. ^2,3
• A 2025 network meta-analysis compared four sphincter-sparing techniques but the included cohorts were mostly high transsphincteric and predominantly retrospective. ⁴

What is unknown / caveats

• No excerpt reports a direct VAAFT/laser-vs-LIFT comparison restricted to low transsphincteric fistulas
• VAAFT and FiLaC are distinct techniques; the question conflates them, and the corpus does not report VAAFT combined with laser closure as a defined comparator
• FiLaC and VAAFT evidence is largely single-center, retrospective, non-comparative
• Included populations skew toward high transsphincteric tracts, not the low transsphincteric subset asked about
• The corpus lacks a subtype-specific randomized or matched comparison, so relative recurrence cannot be established.

References

1. PMID: 38268776. (metadata not in corpus)

2. Sluckin TC, Gispen WH, Jongenotter J, Hazen SJA, Smeets S, van der Bilt JDW, Smeenk RM, Schouten R. Treatment of cryptoglandular fistulas with the fistula tract laser closure (FiLaC™) method in comparison with standard methods: first results of a multicenter retrospective comparative study in the Netherlands. Tech Coloproctol. 2022;26(10):797-803. PMID: 35749023.

3. McCurdy JD, Hartley I, Behrenbruch C, Hart A, Tozer P, Ding NS. Management of Perianal Fistulizing Crohn's Disease According to Principles of Wound Repair. Aliment Pharmacol Ther. 2025;61(4):600-613. PMID: 39757535.

4. Fuschillo G, Pata F, D'Ambrosio M, Selvaggi L, Pescatori M, Selvaggi F, Pellino G. Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis. Tech Coloproctol. 2025;29(1):116. PMID: 40392371.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.