Video-Assisted Anal Fistula Treatment (VAAFT) for complex anorectal fistula: efficacy and risk factors for failure at 3-year follow-up

Regusci, Luca; Fasolini, Fabrizio; Meinero, Piercarlo; Caccia, Giorgio; Ruggeri, Giovanni; Serati, Maurizio; Braga, Andrea

doi:10.1007/s10151-020-02213-w

Cited by 23 publications

(13 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang¹,

Zhao³

et al. 2021

Surg Innov

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Objective. The surgical treatment of complex anal fistulae is very challenging because of the incidence of incontinence after traditional approaches. There are no studies on the role of video-assisted anal fistula treatment (VAAFT) combined with anal fistula plug (AFP) in the complex anal fistulae. The aim of this study was to demonstrate the efficacy of treating complex anal fistulae using VAAFT combined with AFP. Method. This was a retrospective, nonrandomized observational study. 57 consecutive patients with complex anal fistulae who had undergone the VAAFT with AFP in our hospital between April 2016 and December 2019 were included. The primary outcomes were the cure rate, recurrence rate, and Wexner incontinence scores; the secondary outcomes were surgery time, blood loss, wound healing time postoperatively, pain, and patient satisfaction. Results. All 57 patients completed the surgery and follow-up, with an average follow-up time of 28 months; 6 patients suffered with recurrence (recurrence rate: 10.5%). The average surgery time was 57.9 minutes, and the average wound healing time was 46 days. There were no severe postoperative complications, and anal sphincter function was protected in all patients. Conclusions. The treatment of complex anal fistula by VAAFT combined with AFP is safe and effective, has a high healing rate and few postoperative complications, and is a promising surgery that can effectively protect the patient’s anal sphincter function.

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Section: Discussionmentioning

confidence: 99%

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

Zhang¹,

Zhao³

et al. 2021

Surg Innov

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“…Almost all the procedures performed to treat anal fistulae require accurate identification of the internal opening. A few procedures, such as an anal fistula plug, 1,12 videoassisted anal fistula treatment, 13,14 and an over-the-scope clip, 15 involve direct closure of the internal opening. Therefore, the management of such cases is an uphill task and poses a great therapeutic challenge.…”

Section: Internal Opening Not Foundmentioning

confidence: 99%

“…2 These procedures have an overall success rate of 20%-75% while treating anal fistulae. 1,13 On closer scrutiny, it can be observed that most fistulae addressed with these procedures were actually simple fistulae. 2 Therefore, the success rate of these procedures in exclusive complex fistulae is expected to be even lower.…”

Section: Dovepressmentioning

confidence: 99%

<p>Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions</p>

Garg¹,

Sodhi²,

Garg³

2020

CEG

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Anal fistulae can be a very difficult disease to manage. The management of complex fistulae is even more challenging. The risk to the fecal continence mechanism due to damage to the anal sphincters and refractoriness to the treatment (high recurrence rate) pose the two biggest challenges in the management of this disease. Apart from these, there are several other challenges in the treatment of complex fistulae. The intriguing and uphill task is that satisfactory solutions to most of these challenges are still not known, and there is hardly any consensus on whatever treatment solutions are available. To summarize, there is no gold-standard treatment available for treating complex anal fistulae, and the search for a satisfactory treatment option is still on. In this review, the endeavor has been to discuss and highlight recent path-breaking updates in the management of complex anal fistulae.

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“…But if the management of these fistulas was done like ‘complex’ fistulas, then they would have ended up in undergoing one of the sphincter-saving procedures. These sphincter-saving procedures have a lower success rate (40–70%) than fistulotomy [ 9 , 10 ], thereby unnecessarily increasing the risk of recurrence of the fistulas, increasing morbidity and suffering.…”

Section: Discussionmentioning

confidence: 99%

Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients – Cohort study

Garg

2020

Annals of Medicine and Surgery

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Aim/background The commonly used fistula-in-ano classifications, Park or St. James's University hospital(SJUH), neither grade fistulas as per their severity nor guide regarding their management. A new classification(NC), published in 2017, proposed to classify fistulas as per their severity and also guided in its management. The early grades (NC grade I & II) were simple fistulas and were amenable to fistulotomy whereas higher grades (NC grade III-V) were complex fistulas and were not amenable to fistulotomy. Methods Lower grades of all the three classifications were classified as simple (Parks: I, SJUH:I-II, NC:I-II) whereas higher grades were classified as complex (Parks: II-IV, SJUH: III-V, NC: III-V) fistulas. Fistulotomy should be possible in simple fistulas but not in complex fistulas. This was analysed for all these classifications. The long-term follow-up of continence was done by an objective scoring system (Vaizey's scores). Results The SJUH & Parks classifications categorized 504/828 fistulas as ‘complex’ which was quite inaccurate as 42.7%(215/504) of these fistulas were safely amenable to fistulotomy. On the other hand, the New classification (NC) classified 282/828 fistulas as ‘complex’ which was very accurate as 99% (279/282) of these were actually complex and were not amenable to fistulotomy. The change in the preoperative and the postoperative continence scores in the patients who underwent fistulotomy, as per these classifications, Parks & SJUH vs NC, was 0.064 ± 0.62 and 0.089 ± 0.85 respectively and was not significantly different(p = 0.80, Mann-Whitney U test). Conclusions The New classification(NC) seems better than the existing classifications for grading the disease as well as in guiding the management of the disease.

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Video-Assisted Anal Fistula Treatment (VAAFT) for complex anorectal fistula: efficacy and risk factors for failure at 3-year follow-up

Cited by 23 publications

References 25 publications

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

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

<p>Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions</p>

Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients – Cohort study

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