Outcomes in High Perianal Fistula Repair Using Video-Assisted Anal Fistula Treatment Compared With Seton Use: A Randomized Controlled Trial.

Sumera Siddique,Samiullah Bhatti,Shabbar H Changazi,Qamar Ashfaq Ahmad,Aveena Rehman,Zulqarnain Hyidar,Barza Afzal,Mahmood Ayyaz

doi:10.7759/cureus.22166

Abstract

BackgroundAnal fistula, or fistula-in-ano, is a chronic abnormal communication between the epithelialized surface of the anal canal and the perianal skin. Video-assisted anal fistula treatment (VAAFT) is a novel, minimally invasive, and sphincter-saving alternative to traditional seton use. This study aimed to determine the short-term and long-term outcomes of VAAFT compared with seton treatment.Material and methodsThis randomized control trial was conducted at the Department of Surgery, Services Hospital, Lahore, from August 2014 to July 2020. Patients were randomly assigned to either the VAAFT group or the seton group, and postoperative outcomes were assessed for up to three years.ResultsThe study included 80 patients (64 men and 16 women) with a mean age of 39.1 ± 11.2 years. The most common type of fistula was a transsphincteric fistula (n=36, 45%). The mean duration of surgery was significantly longer in the VAAFT group (78.6 minutes) compared with the seton group (36.97 minutes; p=0.000). The mean pain score was significantly higher in the VAAFT group (4.22) compared to the seton group (2.82, p=0.000). The mean time to return to work was shorter in the VAAFT group (7.4 days) than in the seton group (9.2 days, p=0.000). The mean healing time was significantly shorter for patients treated with VAAFT (5.75 weeks) than for those treated with a seton (9.7 weeks; p=0.000). Fistula recurrence after one, two, or three years was not significantly different between groups, and neither group had incidences of anal incontinence.ConclusionsVAAFT is associated with earlier healing time and earlier return to work than the traditional seton technique, with no significant difference in fistula recurrence. VAAFT is minimally invasive and, when used in patients where indicated, allows for a prompter return to routine life for the patients, which is an optimal outcome for both patients and physicians.

Highlights

Anal fistula is the most common perianal disease, with an incidence of nine in 100,000 patients
The mean pain score was significantly higher in the Video-assisted anal fistula treatment (VAAFT) group (4.22) compared to the seton group (2.82, p=0.000)
The mean time to return to work was shorter in the VAAFT group (7.4 days) than in the seton group (9.2 days, p=0.000)

Summary

Introduction

Anal fistula is the most common perianal disease, with an incidence of nine in 100,000 patients. Anal fistula classification is based on the lesion’s location above or below the dentate line, defining a high or low anal fistula. There are typically eight to ten anal crypt glands at the level of the dentate line in the anal canal, arranged circumferentially. These glands provide a path for infectious agents to reach the intramuscular spaces. The cryptoglandular hypothesis states that infection begins in the anal canal glands and progresses into the muscular wall of the anal sphincters to cause an anorectal abscess [2]. Video-assisted anal fistula treatment (VAAFT) is a novel, minimally invasive, and sphincter-saving alternative to traditional seton use. This study aimed to determine the shortterm and long-term outcomes of VAAFT compared with seton treatment

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