Endoscopic Radiofrequency Ablation of Fistula in Ano (E-RaFisTura) in the Era of Surgical Innovation. A Serial Prospective Evaluation of 10 Patients

Abstract

Background: Fistula in-ano is an abnormal chronic infected tunnel (tract) between the rectum or the anal canal and perianal skin usually, with granulation tissue which connecting a primary orifice (internal) to a secondary one (external). This morbid antity represents a dilemma for both, patients and surgeon-proctologists because of postoperative issues occurrence such as fecal incontinence. The surgical management of this infectious condition has emerged nowadays, by emphasing new surgical techniques that preserve anal sphincter's integrity and functional. Over the last decade, numerous techniques sparing anal sphinters have gained popularity such as endoscopic approach (VAAFT), Laser, fibrin glue, transanal advancement flap repair [1,6]. In the same perspective,we are presenting in this paper, our preliminary outcomes of a combination of endoscopic approach (VAAFT) with Radifrequency Ablation of the fistula's tract that we nicknamed with the acronym of E-RaFisTura). Methods: We enrolled 10 males patients with anal fistula, age groupe 50-70 years, without any comorbidity in the term of diabetes mellitus, bowel inflammatory disease. Preoperatively each of them underwent a digital rectal examination, pelvic MRI, colonoscopy to rule out any concomitant abscess, Crohn's disease. Fleet enema, subcutaneus lower molecular weight heparin as well as intravenous broad spectrum antibiotic were administered an hour prior the surgical procedure. All patients were shifted to endoscopic surgical treatment of anal fistula (VAAFT) by using the fistuloscope of Piercarlo Meinero combined to the device of Fistura (Radiofrequency Ablation) with its probe 6-7 F (Figure 1 a,b,c). Then we visualized the fistula's tract and we seal it with radiofrequency thermocoagulation without damaging the anal sphincters by closing the internal opening with a suture node (Vicryl Rapid 3-0). Taxinomically, 2 patients had intersphincteric fistula, 3 transphincteric and the 5 others had submucosal anal fistula. Outcomes: We are inthe third month of follow up, none of the aboved mentioned patients has presented any postoperative issue excepting some local discomfort in immediate postoperative day, relieved with voltaren. Furthermore, the orificial wound healing is successful. Conclusion: Focused on our preliminary results, despite the small volume of patients, this combination of endoscopic and radiofrequency ablation can be regarded with optimism in selected patients. We will perform a powerful prospective study with a huge sample to have more accurate opinion. Bioethics Considerations: All enrolled patients had given their written consent prior. Furthermore,this surgical trial was approved by the Ethical commitee of Our Clinic.