## 4 Discussion  
Anal fistulas continue to be a problem for patients and surgeons, despite scientific advances [1; 7]. New biological products, cell-based treatments, endoscopy and surgical techniques have been introduced, which raises the hope that results can be improved [8; 9]. The treatment for fistulas changed over the years from surgical management to multidisciplinary management when it comes to gastroenterologists' approach to inflammatory bowel disease or other specialties, such as radiology or surgery [10; 11; 12].  
We attempted to evaluate the patients with the mentioned diseases with the aim of reducing surgical interventions. However, in some cases, the persistence of unwanted complications, such as urinary incontinence, which can, of course, be bothersome for the patients and badly influence their daily lives [8; 9].  
Following one year, the healing rate of the fistulas was 50% for the 1-step surgical treatment and 60% for the 2-step surgical treatment (drainage plus medical treatment and then surgical intervention in the 2 nd stage with curative intention). In general, 19.2% of the patients developed postoperative fecal incontinence [2].  
In our study, we observed a 56% healing rate without surgical treatment due to the fact that only 28 patients returned for the 12-month medical check-up, probably because of either healing, going to another medical center, or personal reasons. Of the 28 patients who had local stimulation treatment, neither presented fecal incontinence compared with surgical treatment outcomes [13; 14; 15].  
Transcutaneous laser therapy is a new technique that has an excellent success rate, thus avoiding surgical intervention [16]. To reduce possible postoperative complications, such as discomfort created by the initial treatment used, we chose the laser treatment approach, wherein we observed an advantage regarding the discomfort created during the execution of this intervention and also fewer postoperative complications [17; 18; 19].  
The study showed that the male sex is predominant in this disease; Specifically, 78% in our study are male, and only 22% are female. In our study's time frame, the predominant environment of origin was urban (74%) and fewer were from rural areas (26%), probably because of sedentariness. The main symptom, discomfort in defecation, was always present when the patient was admitted to the hospital; thus, in these conditions, we can say that 100% of people had it on the first day. On the third 3 rd postoperative day, this symptom was present in 72% of the patients, and on the sixth post-treatment day, only 24% still reported discomfort.  
A positive impact was also observed on the perianal supplements with a considerably reduced number of cases. On admission to the hospital, 100% of patients had pathological secretions on the fistula's external orifice, but on the seventh day after the laser treatment, only 13 patients still had supurations. A positive impact was also obtained in perianal discomfort and local pain on the last day of treatment, where only one person still mentioned the discomfort. The biggest influence was tracked in the case of local pain, where the pain disappeared on the third and fourth days post-local laser stimulation.  
Depending on the type and extension of the fistula, the surgical approach can vary from simple drainage to more complex techniques and should always be combined with medical therapy [20; 21]. Our study shows the benefits and positive effects of transcutaneous laser therapy in perianal fistulas, especially regarding the symptoms and healing of the perianal fistula both in the short- and long-term (up to 12 months) [22; 23].  
The laser treatment was also effective in reducing the post-treatment complications over a period from 3 to 12 months, compared with some studies on the surgical treatment of the fistula, obtaining a healing rate of 56% without surgical intervention compared with the estimated percent of 50 to 60% with diverse surgical techniques [24; 25].