Some studies have reported that severe anal pain in a significant proportion of patients treated with high-energy laser (980nm diode laser). This can occur as aresult of the use of higher laser energy volumes for successful adhesion of fistula fragments with a higher hyperthermic effect on the normal sphincter surrounding the fragments. There were no complaints of post operative pain in any of our patients.
The optimal shrinkage effect obtained by heat radiated by a radial tip fiber is limited by the fistula lumen to a radial penetration depth of 2-30 mm of the fistula tract.
A 1470 nm wavelength is believed to be more effective at creating shrinkage and denaturation and to have the optimal absorption curve in water. Surgical trauma is very low and the hyperthermic effect is considered minimal and reversible.
In a comparision operation, patients they used a laser with a wavelength of 980 nm which required 13 W power to seal the tract. For the rest of the patients, they used a laser with a wavelength of 1470 nm with 10 W power. Although no major complication was reported in their study, the patients treated with the 980 nm wavelength laser experienced postoperative pain and anismus. They postulated that the use of higher wave length laser with lower power ( 10 W) settings can provide better post-operative results compared to 980 nm laser with 13 W power.
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