Laser fistula treatment: beyond the controversial aspects: best clinical practice recommendations from an international group of surgeons with extensive experience in the procedure-the FiLaC recommendations.

Background: Fistula tract laser closure (FiLaC) represents a minimally invasive, sphincter-sparing technique for managing fistula in ano with increasing popularity among proctologists. Despite its increasing adoption, significant variations exist in the application of FiLaC in daily practice.

Purpose: The aim of these recommendations was to define some basic principles and recommendations for performing a standard FiLaC procedure.

Methods: The recommendation development group (RDG) consisting of surgeons with experience in the FiLaC were invited to formulate recommendations for the procedure. The recommendations were generated following systematic literature research and discussion amongst experts (expert opinion) where no substantial literature was available. The developed recommendations were voted upon by a panelist via the Delphi process. Consensus was a priori defined as agreement of 75% and above.

Results: The RDG developed 25 recommendations that were voted upon by 21 panelists from 13 nations. Consensus was reached for all 25 recommendations after the first Delphi round.

Conclusion: The FiLaC RDG offers a comprehensive suite of recommendations to enhance the safety and efficacy of standard FiLaC procedures. These 25 detailed recommendations collectively address the full spectrum of FiLaC procedures-from laser settings, preoperative preparations, and perioperative strategies to postoperative care. This coherent framework is anticipated not only to standardize but also to refine the FiLaC technique to ensure best possible surgical outcomes while preserving patient safety.