Current evidence on the safety and efficacy of radially emitting laser fibre treatment of an anal fistula is limited in quantity and quality. Therefore, although there are no major safety concerns, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wishing to do radially emitting laser fibre treatment of an anal fistula should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public on radially emitting laser fibre treatment of an anal fistula is recommended.
Audit and review clinical outcomes of all patients having radially emitting laser fibre treatment of an anal fistula. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion).
The procedure should only be done by clinicians experienced in cannulating fistulas, and who are trained in the use of lasers.
Further research should report details of patient selection, including fistula size, recurrence rates in the medium and long term, and quality-of-life outcomes.