Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience

Abstract

BackgroungAnorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment.AimTo describe the technique and initial experience with the technique video-assisted for anal fistula treatment.TechniqueA Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture.ResultsThe mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient.ConclusionVideo-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

VAAFT versus fistulectomy in the management of anorectal fistulae: a comparative study?

“…[10][11][12] patients who underwent VAAFT the VAS score was always less than 1 on first and second postoperative days. 13 Any complications like bleeding, infection and incontinence were noted. 3 cases undergoing fistulectomy, developed complications, in which two of them had postoperative bleeding which was controlled by anal packing and one of them had perianal infection needing additional antibiotics and slough excision.…”

“…Almost all of them had negligible postoperative pain when compared to their counterparts.so our study concurred with Meinero P et al study in the effectiveness of VAAFT over conventional fistulectomy. 12,13,28 …”

Initial results of using VAAFT in the management of fistula-in-ano: a prospective observational study

“…Mattress suture was used in 5 and linear stapler in 9 had similar findings to VAAFT (Table 4). [24][25][26][27][28][29][30][31][32] Fistula closure techniques like LIFT (Ligation of Intersphincteric Fistula Tract) is another sphincter-saving method. 6,7 It gives promising results amounting to 90% of recovery.…”

Video-Assisted Anal Fistula Treatment (VAAFT): Johor Bahru’s Humble Beginnings

“…No external wound is present post procedure and there is less morbidity. The other added advantage is complete preservation of the anal sphincter [7]. One of the draw backs noted with VAAFT is that it cannot be carried out on patients without any external opening as it sometimes seen in chronic fistulas.…”