Video-assisted anal fistula treatment: a high volume unit initial experience

Abstract

Introduction Perianal fistulas are a common problem. Video-assisted anal fistula treatment is a new technique for the management of this difficult condition. We describe our initial experience with the technique to facilitate the treatment of established perianal fistulas. Methods We reviewed a prospectively maintained database relating to consecutive patients undergoing video-assisted anal fistula treatment in a single unit. Results Seventy-eight consecutive patients had their perianal fistulas treated with video-assistance from November 2014 to June 2016. Complete follow-up data were available in 74 patients, with median follow-up of 14 months (interquartile range 7-19 months). There were no complications and all patients were treated as day cases. Most patients had recurrent disease, with 57 (77%) having had previous fistula surgery. At follow-up, 60 (81%) patients reported themselves 'cured' (asymptomatic) including 5 patients with Crohn's disease and one who had undergone 10 previous surgical procedures. Logistical stepwise regression did not demonstrate any statistically significant factors that may have been considered to affect outcome (age, gender, diabetes, previous I&D, Crohn's disease, smoking, type of fistula). Conclusions Our data have shown that video-assisted anal fistula treatment is safe and effective in the management of perianal fistulas in our patients and this suggests it may be applied to all patients regardless of comorbidity, underlying pathology or type of fistula.

A systematic review of the quality of reporting of interventions in the surgical treatment of Crohn’s anal fistula: an assessment using the TIDiER and Blencowe frameworks

“…Of the 33 included studies, 3 were randomised-controlled trials (RCTs) [ 15 – 17 ], 9 were prospective cohort studies [ 18 – 26 ], 17 were retrospective cohort studies [ 27 – 44 ],2 were phase 1 clinical trials [ 45 , 46 ], and 1 study was a phase 2 clinical trial [ 47 ]. Fourteen of the studies included only Crohn’s patients in their investigation, with the remainder treating a mix of Crohn’s and cryptoglandular fistula.…”

“…Ten interventions were identified. These were anal fistula plug (AFP) ( n = 8) [ 15 , 22 – 24 , 33 , 34 , 36 , 46 ], fibrin glue ( n = 6) [ 17 , 25 , 35 , 40 – 42 ], advancement flap ( n = 4) [ 26 , 32 , 39 , 43 ], fistulotomy ( n = 3) [ 28 , 37 , 38 ], over-the-scope clip (OTSC) ( n = 3) [ 29 , 31 , 44 ], video-assisted anal fistula treatment (VAAFT) ( n = 2) [ 18 , 21 ], adipose-derived stem cells (ASCs) ( n = 3) [ 16 , 45 , 47 ], ligation of intersphincteric fistula track (LIFT) ( n = 2) [ 20 , 27 ], fistula tract laser closure (FiLAC) ( n = 1) [ 19 ], and cone-like resection (CLR) ( n = 1) [ 30 ]. Three studies included more than one intervention [ 34 , 37 , 39 ] (Table 2 ).…”

Efficacy of video-assisted anal fistula treatment combined with closure of the internal opening using a stapler for Parks II anal fistula

“…The VAAFT approach has been extensively studied and was initially applied to anal fistula treatment (12)(13)(14)(15). It is considered to be a potentially effective alternative to conventional anal fistula surgery because of the anal sphincter-saving benefits it offers (14,16,17), even in children (18,19) and patients with Crohn's disease (20,21). Zarin et al applied VAAFT in 40 patients with anal fistulas; the operation failed in three patients, while the remaining 37 patients were followed up for 6 weeks to 6 months: 50% of the 40 patients achieved primary healing and 42.5% achieved secondary healing (22).…”

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.…”