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work after laser closure (e.g., FiLaC) of an uncomplicated anal fistula tract; varies with fistula complexity and job demands."},"complication_rate_pct":{"min":3,"max":15,"unit":"percent","qualifier":"Any early complication (pain, bleeding, infection, retention, discharge); minor continence change under 3%."},"contraindications":["Active abscess or untreated sepsis; drainage first","Very short or superficial tract better treated by other methods","Anorectal malignancy as cause of the fistula","Active severe Crohn's proctitis or uncontrolled IBD (relative)","Unfitness for anesthesia (relative)"],"days_in_clinic":{"min":0,"max":1,"unit":"nights","qualifier":"Usually same-day discharge; one night if needed for anesthesia recovery."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":2,"max":4,"unit":"weeks","qualifier":"Strenuous exercise, once the wound is comfortable and surgeon agrees."},"final_result_months":{"min":1,"max":3,"unit":"months","qualifier":"Time to assess healing of the tract; may take longer in complex fistulas."},"fly_home_after_days":{"min":5,"max":7,"unit":"days","qualifier":"After wound check and once pain, discharge and bowel function are settled; surgeon clearance for sitting during travel."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":4,"max":7,"unit":"days","qualifier":"From the procedure; in-person check before flying home."}},{"purpose":"assessment","requirement":"routine","after":{"min":42,"max":90,"unit":"days","qualifier":"From the procedure; assessment of healing."}}],"indications":["Primary cryptoglandular transsphincteric anal fistula","Recurrent or complex fistula after sepsis drainage and seton placement"],"main_risks":["Persistent or recurrent fistula","Pain, swelling, bleeding","Infection or abscess formation","Temporary discharge","Minor continence disturbance (uncommon)","Urinary retention after regional anesthesia"],"pain":"Usually mild to moderate for several days; controlled with simple analgesics.","preparation":["MRI or endoanal ultrasound to map the tract","Bowel preparation or enema","Fasting per anesthesia instructions","Preliminary drainage or seton placement if sepsis is present"],"recovery_timeline":[{"phase":"First days","description":"Mild pain and some discharge; walking is allowed.","restrictions":["Avoid heavy lifting"]},{"phase":"Weeks 1-4","description":"Gradual return to normal activity as the external opening heals.","restrictions":["Avoid strenuous exercise for 2-4 weeks"]},{"phase":"Months 1-3","description":"Healing is assessed clinically; recurrence may appear in this period.","restrictions":[]}],"rehabilitation_days":{"min":3,"max":14,"unit":"days","qualifier":"Ordinary functional recovery for uncomplicated cases."},"result_longevity":"Healing is permanent when the tract closes fully. Recurrence, if any, usually appears within the first 3-12 months; long-term success is moderate and lower in complex fistulas.","revision_rate_pct":{"min":20,"max":40,"unit":"percent","qualifier":"Persistent or recurrent fistula needing repeat or further surgery within 12 months."},"scars":"No incision; only a small external opening and internal opening site, with minimal scarring.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single laser procedure; a preliminary seton stage may be needed in complex cases."},"stages":[{"code":"laser_closure","label":"Laser closure of fistula tract","after":{"min":0,"max":0,"unit":"days","qualifier":"Day of procedure."}}],"qualifier":"Typical uncomplicated case; repeat treatment only if recurrence."},"success":{"metric":"Complete fistula tract healing","value":65,"unit":"percent of patients","horizon":"12 months","population":"Adults with uncomplicated cryptoglandular transsphincteric fistula treated with FiLaC","evidence_status":"limited"},"techniques":[{"name":"FiLaC (fistula laser closure) with radial laser fiber","suits_whom":"Transsphincteric fistulas with a well-defined tract, after curettage and internal opening closure.","recovery":"Rapid, with minimal wound and low sphincter-injury risk."}],"treatment_conditions":["day_case"],"treatment_duration_hours":{"min":0.5,"max":1,"unit":"hours","qualifier":"Per procedure for a single uncomplicated fistula tract."},"initial_assessment_documents":["Pelvic or perianal fistula MRI report","Colonoscopy report","Previous fistula surgery operative reports","Perianal photos (if available)","Endoanal ultrasound report (if available)"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single laser procedure, same- or next-day discharge; stay 5-7 days for wound check; later healing review remote."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check the qualifications of the medical team that will treat you","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Have you checked the qualifications of the medical team treating you?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C2","text":"Check that you can ask the treating team questions about your treatment","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Have you been able to ask them questions about your treatment?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C3","text":"Check the facilities and standards at the clinic or hospital where you will be treated","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Are you satisfied with the facilities and standards at the clinic or hospital where you'll be treated?","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C4","text":"Check that you understand the possible complications and side effects of the treatment","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Make sure you understand the possible complications and side effects that could arise from your treatment.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C5","text":"Check that you are clear how your aftercare will be coordinated","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Ensure you're clear about how your aftercare will be coordinated.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"C6","text":"Get a second opinion from a doctor on treatment options and whether treatment is necessary","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"A doctor can give you a valuable second opinion as well as advice about treatment options and whether it's necessary.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"Pressure to make a quick decision about treatment 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abroad","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"a hard sell a lack of information pressure to make a quick decision no discussion of possible complications no mention of aftercare","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F4","text":"A hard sell when offering treatment abroad","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"a hard sell a lack of information pressure to make a quick decision no discussion of possible complications no mention of aftercare","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Late 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[ 8 ].","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T2","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you leave.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"alternatives":{"status":"ok","items":[{"id":"A1","text":"You accept a flat scar as the healing outcome","name":"Fistulotomy","source":{"url":"https://www.nhs.uk/conditions/anal-fistula/","host":"nhs.uk","quote":"a fistulotomy – a procedure that involves cutting open the whole length of the fistula so it heals into a flat scar","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200},"operation_id":null},{"id":"A2","text":"You would accept a thread left in place to help healing","name":"Seton placement","source":{"url":"https://www.nhs.uk/conditions/anal-fistula/","host":"nhs.uk","quote":"seton procedures – where a piece of surgical thread called a seton is placed in the fistula and left there for several weeks to help it heal before a further procedure is carried out to treat it","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200},"operation_id":null},{"id":"A3","text":"Your fistula is one of the selected cases this procedure suits","name":"LIFT procedure","source":{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12148987/","host":"pmc.ncbi.nlm.nih.gov","quote":"The LIFT procedure has proven effective in selected cases, with healing rates above 70%, but with limitations in general applicability [ 6 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