Initial results of using VAAFT in the management of fistula-in-ano: a prospective observational study

Abstract

Background: The aim of this study is to present their initial 5-year experience in the treatment of fistula-in-ano by means of VAAFT (Video-Assisted Anal Fistula Treatment).Methods: 76 patients were competent for the VAAFT procedure. Patients were subjected to routine diagnostic tests. 20 patients had classical fistula surgery. In the remaining 56 patient full procedure i.e. diagnostic fistuloscopy, closing the internal ostium, and coagulation of the fistula canal was done. The mean observation period was 23 months.Results: Majority of the cases, inter-sphincter fistula and multiple branching was observed during the diagnostic fistuloscopy. Nine patients had additional fluid compartments. In 56 patients subjected to the full VAAFT procedure the internal ostium was closed using a linear stapler. A recurrence of fistula was observed in one, while non-healing was seen in two patients. Major complications like stool and gas control deterioration (based on the FISI scoring) were not observed in VAAFT operated patients.Conclusions: The VAAFT method preserves sphincter competency, no major intraoperative and postoperative complications were observed. The recovery rate is observed to be comparable with other techniques without the risk of incontinence. It is one of the best method enabling intraoperative visualisation and identification of the internal ostium and fistula canal. Initial optimistic results require further investigations on a larger group of patients.