Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas

Abstract

BackgroundVideo-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for treating complex fistulas. The aim of this report is to describe the procedural steps and preliminary results of VAAFT.MethodsKarl Storz Video Equipment is used. Key steps are visualization of the fistula tract using the fistuloscope, correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening using a stapler or cutaneous-mucosal flap. Diagnostic fistuloscopy under irrigation is followed by an operative phase of fulguration of the fistula tract, closure of the internal opening and suture reinforcement with cyanoacrylate.ResultsFrom May 2006 to May 2011, we operated on 136 patients using VAAFT. Ninety-eight patients were followed up for a minimum of 6 months. No major complications occurred. In most cases, both short-term and long-term postoperative pain was acceptable. Primary healing was achieved in 72 patients (73.5%) within 2–3 months of the operation. Sixty-two patients were followed up for more than 1 year. The percentage of the patients healed after 1 year was 87.1%.Conclusions The main feature of the VAAFT technique is that the procedure is performed entirely under direct endoluminal vision. With this approach, the internal opening can be found in 82.6% of cases. Moreover, fistuloscopy helps to identify any possible secondary tracts or chronic abscesses. The VAAFT technique is sphincter-saving, and the surgical wounds are extremely small. Our preliminary results are very promising.

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

“…The advantage of this procedure is that the internal opening and the secondary tracts or abscess cavities can be accurately identified under direct vision with formal closure of the internal opening in the same sitting [3]. No external wound is present post procedure and there is less morbidity.…”

“…The diagnostic phase is to locate the internal fistula opening and possible secondary tracts or abscess cavities. The operative phase is to destroy of the fistula from the inside, fulgurization of the fistula tract and closure of the internal opening [3]. The fistuloscope is introduced through the external open and the tract is visualized with continuous physiological saline flowing under pressure.…”

“…VAAFT is a new minimally invasive procedure whereby the highlight of this technique is that the fistulous tract can be visualized from inside and eradicated under direct vision [3]. We report our experience with this technique.…”

Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess

“…In 2011, Meinero described a novel technique using a fistuloscope for the treatment of anal fistulae. 5 Video-assisted anal fistula treatment is now recognised as an effective and safe treatment for anal fistula and is associated with reduced morbidity. 6 We report our initial experience of applying the principles of video-assisted surgery for the treatment of acute pilonidal abscesses -endoscopic pilonidal abscess treatment (EPAT).…”

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

“…Of the newer methods being tried VAAFTvideo assisted anal fistula treatment is showing promising results. 3,4 VAAFT can be used both for diagnostic and therapeutic purpose. This procedure doesn't involve tissue cutting and laying open of tract.…”