Throughout the centuries human beings have suffered fromanal fistula.The history of medicine is full of reports about thetreatment of this pathology and, in recent times, whenattention has focused on preserving continence and qualityof life has become a central issue in medical practice, manynew sphincter-saving techniques have been proposed.Few diseases have such a wide range of severity andanatomical variations. The disease spectrum ranges fromsimple submucosal fistula tracts to an extrasphincteric fis-tulas involving multiple tracts and, while the treatment ofthe simplest ones is easy and safe, the more complex fis-tulas require expert surgeons and often multiple operations.The modern surgical approach to anal fistulas includesseveral sphincter-saving procedures including the closureof the fistula tract with plugs, fibrin glue, or collagen pastewithout fistulotomy (i.e., laying open) or by means of fis-tulectomy (i.e., core-out technique) [1]. However, despiteseveral encouraging reports, though few randomized con-trolled trials, there is still some skepticism among colo-proctologists about the effectiveness of these newsphincter-saving procedures.A pretty new conservative proposal to treat anal fistulainvolves the use of energy delivery devices (such as laser)to destroy the chronically inflamed connective tissue of thefistula tract by means of a probe inserted into the fistulatract as is reported in this issue of the journal [2]. Actually,the idea of using laser energy is not completely new as itwas suggested in two studies in 1981 [3] and 1995 [4]butwith different techniques and energy devices.Giamundo et al. [2] draw attention to two critical aspectsof the management of this common and often frustratinganal disease. The first concerns the treatment (or not) of theinternal opening of the fistula. Surgeons of my generationhave been taught and, in turn, we have taught our students,that the key to success of anal fistula treatment is the clo-sure of the primary orifice, where the bacteria come from.Nowadays the proponents of the LIFT operation say thatjust the interruption the fistula tract close to the internalopening is enough to get a 70 % or higher primary healingrate [5], even in complex anorectal fistulas [6]. Similarly,FiLaC consists of blind cauterization of the tract withoutaddressing the internal opening with a long-term successrate of 71 % [2].The second issue concerns the management of the fistulatract itself. Several attempts have been made to helpspontaneous healing using biological glues (fibrin [7],collagen paste [8]), plugs of collagen matrix [9, 10] and aplethora of other methods including adipose-derived stemcells [11], but the results in the real world of surgicalpractice are often disappointing despite some enthusiastic(uncontrolled) reports (but we know from Feinstein that‘‘reports with enthusiasm have no controls and reports withcontrols have no enthusiasm’’ [12]). In the FiLaC techniquethe chronically inflamed connective tissue is ‘‘burned’’ bythe laser energy allowing tissue repair by the macrophagesand fibroblasts coming from the surrounding healthy con-nective tissue [13]. The results obtained by the few authorswho have used this new technique are really exciting [2,13, 14] but, since the commonest bias in clinical research isto fall in love with our own ideas or personal technique, wedo need to test the reproducibility of this new technique onlarger series and to ‘‘pass the exam’’ of randomized con-trolled trials comparing the new procedure with othersurgical techniques used to treat anal fistulas.