Video‐assisted anal fistula treatment for complex anal fistula: a long‐term follow‐up study

Abstract

AimThis prospective study aimed to evaluate the safety and efficacy of video‐assisted anal fistula treatment (VAAFT) in complex fistula‐in‐ano (FIA).MethodConsecutive patients presenting with complex FIA were recruited between November 2012 and November 2018. The primary outcome was healing of the fistula.ResultsSeventy‐two patients were included, 39 (54%) of whom were men, with a mean age of 46 (±11) years. The mean follow‐up was 32 (±18) months. Complete healing was achieved in 64 (89%) patients. When persistent and recurrent cases were considered together, the failure rate was 21% and the success rate 79%. When patients failed, they were offered VAAFT again, after which there was an in increase in the healing rate, which overall (primary and secondary) was 86%. There was no statistically significant deterioration in continence. Eight (11%) patients experienced postoperative complications which required no additional surgical intervention.ConclusionVAAFT represents a promising, sphincter‐saving technique for the treatment of complex FIA. It has proved efficacious, with 79% of patients achieving complete healing after its primary application. After a second use, this reached 86%. The main advantage of VAAFT compared with other sphincter‐saving techniques is working under direct vision. VAAFT has a good safety profile with 11% of patients experiencing minor complications, and there is no effect on continence.

Long term efficacy of Video‐Assisted Anal Fistula Treatment (VAAFT) for complex fistula‐in‐ano: a single‐centre Australian experience

“…In our study, the rate of primary healing was lower than that seen in the two VAAFT meta‐analyses performed to date (covering 12 individual studies) which reported pooled rates of healing of 82.3% at 9 months median follow up 19 and 76% at 7 months follow up 22 . Studies performed since these reviews have demonstrated primary healing rates ranging from 54% to 81% at follow up ranging from 6 to 36 months 23–28 . The lower rate of primary healing witnessed in our study is perhaps explained by the complexity of included disease, but also the longer duration of follow up (mean 59.5 months).…”

Treatment of Complex Anal Fistula by Video-Assisted Anal Fistula Treatment Combined with Anal Fistula Plug: A Single-Center Study

“…There were 6 cases of recurrence after surgery, with a recurrence rate of 10.5%, showing results consistent with those recently reported. 8,21,22 Video-assisted anal fistula treatment is a cutting-edge technology that has been used in China for less than 5 years and needs further investigation. In particular, the characteristics of the anatomy under the endoscope should be well studied for each procedure.…”

“…Primary outcomes were the cure rate and recurrence rate 8 and Wexner incontinence scores for anal sphincter function. 9 Healing was defined as an absence of discharge and closure of the external opening for 6 months postoperatively (Figure 7).…”

Research on high anal fistula: a bibliometric analysis

“…It is still unclear whether video assistance is critical to the success of the surgery; some supporters believe that even the lesions missed by MRI can be found using VAAFT. However, there is currently a lack of evidence to support this view, and more detailed research needs to be conducted (27,28).…”