One of five fistula operations · see all techniques
FiLaC (Fistula-tract Laser Closure): when laser is the right fistula operation
FiLaC seals a fistula tract from the inside with a radial laser fibre — no sphincter muscle is cut. It suits a single, mature trans-sphincteric tract where the patient wants to avoid a muscle-dividing operation. It is a day-care procedure; most desk workers are back in 2–5 days (results vary). Performed by Dr. Kundan Kharde at Sharvari Hospital, Pimple Nilakh, Pune — 5 min from Wakad.
Who is this operation for?
FiLaC sits in the deep-tract row of Dr. Kharde's framework: a tract crossing more than half of the external sphincter, where laying it open would risk continence. It is used alone for a single mature tract, or as the distal part of a combination operation (proximal fistulotomy + laser). It is not for an undrained abscess or a branching tract. Almost every fistula at Sharvari Hospital is imaged before surgery — MRI fistulogram or trans-rectal ultrasound — and the tract on that scan decides the operation (how Dr. Kharde decides).
How is it done?
- Anaesthesia and probing. Spinal or short general anaesthesia; the tract is probed to confirm the path seen on the MRI or ultrasound.
- Tract preparation. The tract is brushed and irrigated to clear granulation tissue so the laser reaches the tract wall.
- Laser closure. A radial-emitting fibre is passed to the internal opening and withdrawn slowly while firing, shrinking and sealing the tract wall along its length.
- Internal opening. Closed with a stitch or small mucosal flap so stool cannot re-enter the sealed tract.
- External opening. Left slightly open to drain; light dressing. No sphincter muscle is divided.
About 20–40 minutes · no incision beyond the existing opening · both sphincters preserved.
What does recovery look like?
| Day | Discharge & follow-up | Dressing & bowel movement | Return to work |
|---|---|---|---|
| Day 1 | Same-day discharge after observation; walking and normal diet that evening. | Light dressing; sitz-bath routine taught; first bowel movement next day with a stool softener. | Rest at home; antibiotics and painkillers as prescribed. |
| Day 7 | Free first review at the hospital. | Twice-daily sitz baths; a little discharge from the external opening is expected. | Desk work from Day 2–5; no gym or long drives yet (results vary). |
| Day 30 | Healing review; MRI only if healing is slow. | External opening closed or closing; sphincter function unchanged. | Resume gym, cycling and long sitting. |
Same 30-day roadmap as the main fistula page. Results vary.
What are the risks and the alternatives?
- •Bleeding: minor spotting is usual; heavy bleeding is uncommon and is an emergency (we are open 24×7).
- •Infection: fever, rising pain or new swelling needs review; antibiotics are prescribed routinely.
- •Non-healing or recurrence is the main risk — published series report healing in roughly 60–70% of selected tracts (literature range, not Sharvari data). A failed FiLaC can be repeated or converted to LIFT or a staged plan; results depend on tract anatomy.
- •Continence change: very low risk — no sphincter muscle is divided, which is why FiLaC is chosen for deep tracts.
- • Alternatives: Fistulotomy / fistulectomy, LIFT, VAAFT, Seton (staged) — the imaging decides which.
Technique selection follows the ASCRS Clinical Practice Guideline for Anorectal Abscess, Fistula-in-Ano and Rectovaginal Fistula (2022).
How does FiLaC laser compare?
FiLaC gives the fastest return to work of the sphincter-preserving operations, at the cost of a lower published healing range than fistulotomy.
| Technique | Best for | Sphincter cut? | Day-care? | Typical return to desk work | Published healing range* | Recurrence risk |
|---|---|---|---|---|---|---|
| Fistulotomy / fistulectomy | Simple, superficial tract, <30% sphincter | Yes, minimal | Yes | 3–7 days | ~90–95% | Low |
| LIFT | Trans-sphincteric tract; intact sphincter needed | No | Yes | 5–10 days | ~60–80% | Moderate |
| FiLaC (laser) (this page) | Trans-sphincteric tract; patient wants no cut | No | Yes | 2–5 days | ~60–70% | Moderate |
| VAAFT | Complex / branched tract, unclear internal opening | No | Yes | 3–7 days | ~70–80% | Moderate |
| Seton (staged) | Active sepsis; high / recurrent / horseshoe; Crohn's | No (drainage) | Yes (stage 1) | 2–5 days per stage | Bridge to definitive operation | n/a |
*Published literature ranges, not Sharvari outcome data; results vary and depend on tract anatomy.
Why have it at Sharvari Hospital?
- ✓Routine pre-operative imaging — MRI fistulogram or trans-rectal ultrasound for almost every fistula.
- ✓Same surgeon consults and operates — Dr. Kundan Kharde, MS, FMAS, 19+ years, 6,000+ surgeries (Dr Kharde's fistula profile).
- ✓Our own 50-bed hospital, open 24×7 — in-house beds if anything needs observation.
- ✓Cashless with 50+ insurers — pre-authorisation by our TPA desk. ISO 9001:2015 · PCMC Reg. 884.
Frequently asked questions
Does FiLaC work for every fistula? +
No. FiLaC needs a single, mature tract with a clear internal opening and no abscess or side branches; healing depends on tract anatomy. That is why almost every fistula at Sharvari Hospital is imaged first — the scan shows whether laser alone is enough or a combination or staged operation is safer.
Is FiLaC the same as the 'laser fistula treatment' advertised by chains? +
Usually yes — FiLaC is the laser-closure technique those advertisements describe. What differs is selection. Laser on an unimaged, branching or septic tract fails; laser on the right tract, chosen after imaging by the surgeon who operates, performs within the published range. Ask who images, who decides, who operates, and what happens if the tract proves unsuitable.
What if FiLaC fails? +
The tract is re-imaged to see why — a missed branch, an undrained pocket or a reopened internal opening. The options are then a repeat FiLaC, a LIFT procedure, or a seton followed by a definitive operation. A failed laser uses no sphincter muscle, so every option stays open. Results vary.
How long does FiLaC take? +
The laser part takes about 20–40 minutes under spinal or short general anaesthesia. With admission and a few hours of observation, most patients spend about half a day at Sharvari Hospital and go home the same day. Combination operations (fistulotomy plus laser) take somewhat longer.
Is FiLaC covered by insurance? +
Fistula surgery, including laser closure, is covered by most Indian health policies once the waiting period has passed. Sharvari Hospital is cashless with 50+ insurers and the TPA desk handles pre-authorisation. Cost, insurance and bed details are on the main fistula treatment page.
Cost, insurance and beds: see the full fistula treatment page.
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