Video-assisted Anal Fistula Treatment Research Articles

Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating

Background and aimsVideo-assisted anal fistula treatment (VAAFT) is an innovative surgical approach enabling the direct visualization of the fistula tract structure. This study aims to assess the efficacy of VAAFT in comparison with that of traditional surgical methods and explore potential risk factors contributing to fistula recurrence to provide new recommendations for surgical selection.Materials and methodsInformation was collected from 100 patients with complex anal fistula (CAF) in our hospital who underwent surgical treatment from January 2021 to January 2023. We compared the baseline information and surgical outcomes of two groups, analyzed the risk factors for fistula recurrence by using logistic regression analysis, and conducted further exploration by using the body mass index.ResultsEqual numbers of patients underwent VAAFT and traditional surgeries, and no significant differences in baseline information were observed. Patients who received VAAFT experienced less intraoperative bleeding (15.5 (14.0–20.0) vs. 32.0 (25.0–36.0)), shorter hospital stays (2.0 (2.0–2.5) vs. 3.0 (3.0–3.5)), reduced postoperative pain and wound discharge, but longer operative times (43.3 ± 6.9 vs. 35.0 (31.5–40.0)) compared with patients who underwent traditional surgeries. No significant differences in recurrence rates were found three and six months after operation (the p-values were 0.790 and 0.806, respectively). However, the Wexner scores of the VAAFT group were significantly low in the first follow-up (0 (0–1.0) vs. 2.0 (1.0–2.0)). Postoperative recurrence of fistulas may be associated with obesity (p-value = 0.040), especially in patients undergoing traditional surgeries (p-value = 0.036).ConclusionVAAFT offers advantages, such as less pain, less trauma, and faster recovery, compared with traditional surgical treatment. Obese patients with CAF are prone to recurrence, and we recommend that they undergo VAAFT treatment rather than traditional surgeries.

Video-assisted anal fistula treatment (VAAFT) combined with ozonide oil dressing: standardization of technique in pediatric patients

BackgroundAnal fistula and perianal abscess are commonly acquired anorectal pathologies in children. Surgical treatment options commonly adopted are fistulotomy, fistulectomy, cutting seton placement, and more recently video-assisted anal fistula treatment (VAAFT). Optimal postoperative wound dressing remains debated. This study aimed to report our series of pediatric patients, who received VAAFT and postoperative wound dressing using ozonide oil.MethodsAll patients who underwent VAAFT between August 2018 and May 2023 were included in the study. Demographics, clinical features, pre-operative imaging, surgical details, outcome, and mid-term outcome data were retrospectively reviewed for each patient. All VAAFT procedures were performed under general anesthesia and using a 10-Ch fistuloscope.ResultsThirty-three VAAFT procedures were performed in 30 patients over the study period. The median patient age was 5.7 years (range 1.75–14). Anal fistula was idiopathic in 26/30 (86.6%), iatrogenic in 2/30 (6.7%), and secondary to Crohn’s disease in 2/30 (6.7%). The median duration of surgery was 23 min (range 18–40). All patients received ozonide oil dressing twice a day for 5 weeks postoperatively. The median hospital stay was 24 h (range 9–36). The median healing time was 28 days (range 17–39). With a median follow-up of 2 years (range 0.5–5), disease recurrence occurred in 3/30 (10%) patients with idiopathic fistula, who were re-operated using the same technique, with no further recurrence. No fecal incontinence or soiling was observed.ConclusionOur series confirmed that VAAFT is a safe and effective technique to treat children with perianal fistula. The technique is versatile, allowing to treat fistulae of different etiologies. Postoperative course was painless and fast. Future comparative prospective studies are needed to better establish these conclusions.

Efficacy and safety of video-assisted anal fistula treatment in anorectal fistula: a meta-analysis.

By searching relevant literature, the recurrence rate, complication rate after video-assisted anal fistula treatment (VAAFT), and efficacy and safety of the treatment were analyzed. Articles that reported the outcomes of VAAFT up to December 2020 were searched in PubMed (Medline) and Cochrane Library, in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) screening guidelines. Two researchers independently completed the whole process from screening and inclusion to quality evaluation and bias risk assessment, and the data was included in the RevMan 5.3 software for analysis. The main outcomes were demographic data of patients, detection rate, classification of internal opening of anorectal fistula, postoperative recurrence rate, and incidence of complications. A total of 10 articles were included (779 patients). The average age of the patients was 44 years old, average operation time was 60 min, and the average follow-up time was 22 months. The ratio of male to female was 2.4:1, the ratio of high anorectal fistula to low anorectal fistula was 6.6:1, the detection rate of internal openings was 98%, the weighted recurrence rate was 24%, and the weighted complication rate was 1%. VAAFT is effective and safe in the treatment of anorectal fistulas.

Long term results of video-assisted anal fistula treatment for complex anal fistula: another shattered dream?

Complex anal fistula represents a burden for patients, and its management is a challenge for surgeons. Video-assisted anal fistula treatment (VAAFT) is one sphincter-sparing technique. However, data on its long-term effectiveness are scant. We aimed to explore the outcomes of VAAFT in a retrospective cohort of patients referred to a tertiary centre. Consecutive adult patients with a minimum of 2 years' follow-up after VAAFT were reviewed. Patients were followed up to 5 years postoperatively. Failure was defined as incomplete healing of the external orifice(s) during the first 6 months. Recurrence was defined as new radiologically and/or clinically confirmed onset of the fistula after primary healing. A generalized linear model was fitted to evaluate the association between failure and sociodemographic characteristics. Predictors of recurrence were determined in a subgroup analysis of patients found to be free from disease at 6 months postoperatively. Overall, 106 patients (70% male; mean age 41 years) were reviewed. Of these 86% had a previous seton placement. Fistulas were either high trans-sphincteric (74%), suprasphincteric (12%) or extrasphincteric (13%). Eight (7%) patients experienced postoperative complications, none of which required reintervention. Mean follow-up was 53 ± 13.2 months. VAAFT failed in 14 (13%) patients. The overall recurrence rate ranged from 29% at 1 year to 63% at 5 years. Multiple external orifices, suprasphincteric fistula, younger age, previous surgery and higher complexity of the fistulous tract were independent risk factors for recurrence. VAAFT is a safe sphincter-sparing technique. The initially high success rate decreases over time and relates to a higher degree of complexity.

A CASE STUDY ON A COMPLEX FISTULA-IN-ANO BY AYURVEDIC MANAGEMENT

Fistula-in-ano can be a complicated disease to manage. An anal fistula is divided into simple and complex fistula. Managing complex fistula is even more challenging, which typically affects younger people and causes persistent morbidity. It is pertinent to define complex anal fistula. From a practical point of view, a fistula that is difficult to manage has a higher risk of recurrence, poses a greater threat to continence and is classified as a complex fistula. Due to its difficulty in treating medically and surgically, Bhagandara (fistula-in-ano) is one of the eight major disorders classified under Astamahagada in Ayurveda. Ayurvedic surgeons frequently use the effective fistula treatment known as Ksharasutra; however, cutting the passage takes a very long time. As a result, this procedure is now sometimes referred to as partial fistulectomy with Ksharasutra ligation, fibrin glue, fistula plug (FP), Fistula-tract Laser Closure (FiLaC), Seton techniques, video-assisted anal fistula treatment (VAAFT), LIFT (ligation of intersphincteric fistulous tract), and IFTAK (interception of fistulous tract with application of Ksharasutra), also known as window technique, where the Guggulu based Apamarg Ksharasutra is placed. This method shortens the healing time and allows repairing such a complicated fistula-in-ano with little tissue injury. Infected anal crypt, secondary extension and related conditions are the key factors that lead to the recurrence of complex anal fistulas. Surgery in complex anal fistula aims to prevent recurrence, avoid incontinence and avoid damaging the sphincter muscles (the ring of muscles that open and close the anus).

A pilot study on staged surgery by delta video-assisted anal fistula treatment (dVAAFT) for complex anal fistula

Complex anal fistulas (CAF) present a challenge in achieving healing while preserving anal sphincter function. This study aims to introduce a novel staged approach for CAF treatment, combining video-assisted anal fistula treatment (VAAFT), seton placement, and other staged approaches. Consecutive patients with CAF underwent the staged approach involving VAAFT and seton placement. Data on patient demographics, fistula characteristics, and operative findings were collected. Pre-operative work-up included clinical evaluation, endoanal ultrasonography (EAUS), and magnetic resonance imaging (MRI). Surgical techniques and outcomes were evaluated. Eighteen patients (median age 38 years) were included. Misplacement of a previously placed seton was observed in 64% of cases. VAAFT combined with seton placement achieved simplification and healing of secondary tracts in 66% of cases. Operative times significantly decreased across interventions. At a median follow-up of 14 months, complete healing was achieved in 2 patients, with 1 patient demonstrating persistence of the fistula. Post-operative complications were observed in 11% of patients, with no deterioration in continence. The staged approach combining VAAFT, seton placement, and staged procedures offers a potential solution for treating CAF. VAAFT provides diagnostic and therapeutic benefits, simplifying the fistula anatomy and optimizing seton placement. The approach allows subsequent procedures based on individual fistula characteristics.

Surgery of Simple and Complex Anal Fistulae in Adults: A Review of the Literature for Optimal Surgical Outcomes.

Anal fistulas are common anorectal conditions, and surgery is the primary treatment option. In the last 20 years of literature, there exist a large number of surgical procedures, especially for the treatment of complex anal fistulas, as they present more recurrences and continence problems than simple anal fistulas. To date, there are no guidelines for choosing the best technique. We conducted a recent literature review, mainly the last 20 years, based on the PubMed and Google Scholar medical databases, with the goal of identifying the surgical procedures with the highest success rates, lowest recurrence rates, and best safety profiles. Clinical trials, retrospective studies, review articles, comparative studies, recent systematic reviews, and meta-analyses for various surgical techniques, as well as the latest guidelines of the American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, and the German S3 guidelines on simple and complex fistulas were reviewed. According to the literature, there is no recommendation for the optimal surgical technique. The etiology, complexity, and many other factors affect the outcome. In simple intersphincteric anal fistulas, fistulotomy is the procedure of choice. In simple low transsphincteric fistulas, the patient's selection is crucial in order to perform a safe fistulotomy or another sphincter-saving technique. The healing rate in simple anal fistulas is higher than 95% with low recurrence and without significant postoperative complications. In complex anal fistulas, only sphincter-saving techniques should be used; the optimal outcomes are obtained by the ligation of the intersphincteric fistulous tract (LIFT) and rectal advancement flaps. Those techniques assure high healing rates of 60-90%. The novel technique of the transanal opening of the intersphincteric space (TROPIS) is under evaluation. The novel sphincter-saving techniques of fistula laser closure (FiLac) and video-assisted anal fistula treatment (VAAFT) are safe, with reported healing rates ranging from 65% to 90%. Surgeons should be familiar with all sphincter-saving techniques in order to face the variability of the fistulas-in-ano. Currently, there is no universally superior technique that can treat all fistulas.

VAAFT PROCEDURE (Video-assisted Anal Fistula Treatment) versus Open Method in the Treatment of High Fistula in Ano

Abstract Background A common acquired anorectal condition is anal fistula. The treatment approaches that have been employed have been linked to erratic outcomes and sometimes life-threatening consequences. Video-assisted anal fistula treatment (VAAFT), a minimally invasive method, was introduced for adult patients in 2011. Objective To know the efficacy of the VAAFT procedure in treating high anal fistulas and to compare it to open methods in the Basrah province. Methods The present study was performed on 200 patients with high fistulas in ano in Basrah province. We divided the patients into 2 groups: Group A: treated by the VAAFT technique and Group B: treated by open fistulotomy Results The patients treated with VAFFT revealed no occurrence of the following postoperative complication: Infection, incontinence, recurrence, anal stenosis, and bleeding. There was lower incidence of pain, short time for wound healing, rapid return to work, and more patient satisfaction compared with open fistulotomy Conclusion An innovative method for managing ano fistula is VAAFT. Compared with traditional methods, it has a lot of benefits. It is day case surgeryno open wound.no damage to anal sphincter and no risk of incontinence, it is more affordable.it allow for clear identification of internal office, whole tract and its associated branches and cavity. The instrument can be used for multiple patients after good sterilization and disinfection.

Regenerative and Endoscopic Treatment of Complex Recurrent Fistula in Ano: When Technology Supports Clinical Treatment

Background: Recurrent anal fistulas present a challenge to surgeons due to the high risk of post-operative incontinence caused by repeated surgery. The correct identification of the anatomy of the main and secondary fistula tracts and the individuation of abscess cavities are fundamental for correct treatment. Intraoperative endoscopic evaluation and the complete destruction of the fistula pathway can be achieved through video-assisted anal fistula treatment (VAAFT). Furthermore, the injection of human autologous Microfractured Adipose Tissue (MFAT) processed by a Lipogems® device can be used as both a bulking agent and a regenerative technique. Methods: A combined approach of VAAFT plus Microfractured Adipose Tissue Graft (MFAT) is proposed in order to treat recurrent and complex fistula in ano. Results: Three cases treated with a combination of VAAFT and MFAT grafts are described. All cases had undergone multiple interventions at the perianal level over a period ranging from 1 to 15 years. One case certainly failed due to poor patient compliance, but in the remaining two cases, the patients made a complete recovery with the disappearance of symptoms over a follow-up period of one to two years. Conclusion: The combination of video-assisted anal fistula treatment and injection of human autologous microfractured adipose tissue may be a valid, safe and feasible therapeutic option. MFAT injections are more effective in promoting tissue regeneration than simply “filling” the fistula tract and are common practice also in the treatment of Crohn’s Disease due to the immunomodulatory power of mesenchymal cells.

Comparison of Recurrence of High Trans-Sphinteric Anal Fistula After Vaaft and Tight Setons in Military Hospital Rawalpindi

Objective: To compare the recurrence rate in patients undergoing fistulectomy using tight setons with those using videoassisted anal fistula treatment (VAAFT).
 Study Design: Comparative prospective study.
 Place and Duration of Study: Department of General Surgery, MH Rawalpindi, Pakistan from May 2018 to Dec 2021.
 Methodology: We included 200 patients with high trans-sphincteric anal fistula (simple or complex) of age 18 to 60 years, having ASA I or II. Group- A comprised patients undergoing treatment with VAAFT, while Group- B included patients undergoing treatment with Tight Seton in conventional surgery. Patients were followed for three months after the procedure. Patients having a history of discharge around or in the vicinity of the previous external opening of the anal fistula were labelled as having a recurrence. Recurrence was confirmed on MRI Fistulogram.
 Results: The mean age of patients in Group-A was 42.10±8.26 years, and in Group-B was 42.17±7.91 years (p=0.95). There were 58 male patients in Group-A and 55 male patients in Group-B (p=0.67). The mean duration of the fistula was 5.30±1.64 months in Group-A and 5.22±1.61 months in Group-B (p=0.72). Recurrence was diagnosed in 24 patients in Group-B and only 06 patients in Group-A (p<0.001).
 Conclusion: Video-assisted anal fistula treatment (VAAFT) has a lower recurrence rate than Tight Setons in conventional surgery in treating high trans-sphinteric anal fistula.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton

Tissue engineering is a promising field for treating various diseases using tissue-like structures generated through biomaterials, scaffolds, nanoparticles, biomolecules, and stem cells. This advanced method is considered one of the next-generation therapeutic techniques that may solve the therapeutic challenges in treating perianal fistula based on seton therapy. Remarkable advances in stem cell biology, genetics, biomaterials, fabrication technologies, and nanotechnology have provided the opportunity to implement this multidisciplinary approach to repair damaged tissue in the seton-based fistula treatment. In addition, tissue engineering provides us with nanostructured biomaterials to fabricate setons that can act as scaffolds, with modified mechanical and biological properties such as antibacterial and anti-inflammatory. This review focuses on the applications, advantages, and future perspectives of tissue engineering to enhance the seton placement techniques and present a novel therapeutic solution to treat perianal fistula. In addition, in vivo and in vitro studies about implementing tissue engineering in the treatment of perianal fistula are reported in this study. Also, it summarizes the surgical procedures for the treatment of fistula, including Ligation of the Intersphincteric Fistula Tract (LIFT), Fistula Laser Closure (FiLaC™), Over-The-Scope Clip System (OTSC), Video-assisted anal fistula treatment (VAAFT), Anal fistula plug (AFP), and Rectal advancement flap (RAF). Furthermore, the applications and properties of different setons including, cutting setons (Penrose drains, rubber band, polypropylene, and silk), non-cutting setons (loose, knot-free, Comfort, and Super Seton®), and chemical setons (Ksharasutra) are described. In the end, we present the challenges and future trends of implementing tissue engineering technology in the seton-based therapy for the treatment of perianal fistula. The applications of tissue engineering in seton-based fistula therapy. The scaffolds with controllable mechanical properties and degradation rate can have antibacterial, anti-inflammatory, and drug-releasing properties. Besides, the scaffolds can be incorporated or covered with stem cells to regenerate damaged tissues in the perianal fistula site.

Fistula in Ano: A Modified Approach - A Case Report

Management of fistula is one the most notorious job for the surgeon because of its ill site, chronicity, and recurrences. Treatment modalities like anal fistula plug, mucosal flap advancement, fibrin glue, and VAAFT (Video Assisted Anal Fistula Treatment) are there but ksharsutra has edge on them for its success rate and non-recurrence. Even after its better results, weekly sitting and pain during changing of ksharsutra and discomfort of ksharsutra being in situ makes it difficult for patient to pursue the treatment. Hence, a new approach was mandatory. Considering fistula to be a dushtavrana, shashti upakrama like lekhan, shodhan and ropan were applied in a patient of high-anal transphincteric fistula. Partial fistulectomy, excessive curettage (lekhan) from its internal opening was done. Internal opening was closed and wound was allowed to heal by second intension with the help of shodhan and ropan tail. Post-operative antibiotics and anti-inflammatory were given. It was observed that wound healed at good rate without discomfort of patient in 25 days. It underlines importance of shashtiupkrama in modern age of surgery also.

Video-assisted anal fistula treatment for complex anorectal fistulas in adults: a systematic review and meta-analysis.

Video-assisted anal fistula treatment (VAAFT) has gained increasing acceptance as a sphincter-sparing procedure for treating complex anorectal fistulas (CAF), but no unequivocal conclusions can yet be drawn regarding its ultimate effectiveness. We reviewed the literature and performed a meta-analysis to evaluate the efficacy and safety of VAAFT in CAF patients. The study protocol was registered with the PROSPERO database (CRD42021279085). A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases up to June 2021 with no restriction on language based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the keywords video-assisted surgery, video-assisted anal fistula treatment, and complex anorectal fistula to identify relevant studies. Fourteen trials (7 prospective and 7 retrospective)with a total of 1201 patients (mean age 43.5years) were included. The median follow-up duration was 16.5(8-48) months. Pooled analysis showed that the rates of success, recurrence and postoperative complication across the studies were 83% (95% CI 81-85%, I2 = 37.9%), 16% (95% CI 14-18%, I2 = 4.8%), 11% (95% CI 7-15%, I2 = 72.1%), respectively. The postoperative Jorge-Wexner score used to assess the level of anal incontinence was 1.09 (95% CI, 0.9-1.27, I2 = 74.6%). The internal opening detection rate was 97.6% (95% CI 96.1-99.6%, I2 = 48.2%). Recurrence rates varied according to the closure method of internal opening from 21.4% after using staplers, 18.7% after suturing, to 23.5% after advancement flap. The hospital stay was 3.15days (95% CI 2.96-3.35, I2 = 49.7%). Subgroup analysis indicated thatthe risk of heterogeneity in the urine retention group was higher compared with that of the overall group andthat retrospective studies may be the source of heterogeneity for postoperative anal incontinence.r . Sensitivity analysis confirmed the stability of the pooled results. Begg's and Egger's tests showed no evidence of publication bias. According to the available evidence, VAAFT may be a valuable alternative to fistulotomy or seton in treating CAF and has the additional long-term benefits of reducing anal incontinence and surgical morbidity, permitting earlier healing and accelerated rehabilitation.

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

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.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

Fibrin glue versus autologous platelet-rich fibrin - comparison of effectiveness on the cohort of patients with fistula-in-ano undergoing video-assisted anal fistula treatment.

Context:Minimally invasive sphincter preserving procedures like ligation of intersphincteric fistula tract (LIFT) and video-assisted anal fistula treatment (VAAFT) are being increasingly used in the treatment of fistula-in-ano. The addition of adjuncts like fibrin glue has improved the results for VAAFT. Our unit has used platelet-rich fibrin (PRF) as an innovative adjunct for VAAFT.Aims:To compare the effectiveness of two different adjuncts, fibrin glue and autologous PRF, used to fill the treated fistula tracts following VAAFT.Settings and Design:Retrospective observational study on a cohort of patients undergoing VAAFT at a tertiary centre between 2015 and 2020 comparing two adjuncts used with VAAFT procedure.Subjects and Methods:Data of patients who underwent VAAFT for fistula-in-ano were obtained from the hospital database. Group A included patients treated with fibrin as adjunct and PRF as adjunct in Group B. Patients were followed up at 1, 3 and 6 months post-operatively and by a telephonic interview in 2020 to ascertain recent status. All data were entered into an excel sheet.Statistical Analysis Used:Data were analysed using SPSS V20 to test the statistical significance of the difference in the mean healing time between two groups, Mann–Whitney U-test was used and for age, Student's t-test was used.Results:There were 41 patients in Group A and 24 in Group B. There was a significant reduction in recurrence rate in Group B (P = 0.032) and in those patients who had a single internal opening (P = 0.045), single external opening (P = 0.03) and complex tracts (P = 0.033). PRF was cheaper than Fibrin glue.Conclusions:PRF is more effective and economical with lower recurrence rates.

Long term efficacy of Video-Assisted Anal Fistula Treatment (VAAFT) for complex fistula-in-ano: a single-centre Australian experience.

Video-Assisted Anal Fistula Treatment (VAAFT) is a novel minimally invasive & sphincter-saving technique for treating complex fistula-in-ano involving endoscopic assessment & treatment of perianal fistula. This retrospective, non-randomized, observational study is the first Australian study of VAAFT. It is also the longest study of VAAFT to-date. From January 2014 to September 2019, 59 patients with a complex anal fistula were identified via MRI & underwent VAAFT. Fourteen patients had undergone previous definitive surgery for anal fistula. Specialized Karl Storz video equipment (fistuloscope) was used in the procedure. The rigid fistuloscope was used to directly visualize the fistula tract/s & internal opening. Closure of the internal opening was then performed. The fistula tract/s were then treated via fulguration. The external opening was kept patent & dressed. Patients were then followed up for a mean 59.5months. 67.9% (n= 38) of patients achieved primary healing (needing nil further intervention) at a median of 13 weeks. 12.5% (n= 7) experienced healing followed by recurrence while 19.6% (n= 11) experienced non-healing. Of the recurrence/non-healing groups, 11/18 underwent repeat VAAFT with healing occurring in 10/11 patients at a median of 7 weeks. The mean operating time was 41.1min. There were no major complications & continence scores were not affected. Three patients were lost to follow up. VAAFT is both effective & safe for the treatment of complex fistula-in-ano. Its minimally invasive nature means that in the instance of recurrence or persistence, VAAFT can be repeated with minimal morbidity & reasonable likelihood of success.

Vaaft (Video Assisted Anal Fistula Treatment); Novel Technique For The Treatment Of Anal Fistula.

VAAFT (Video Assisted Anal Fistula Treatment) is a novel minimally invasive technique for treatment of Fistula in Ano, which claims superior results compared to current treatment modalities due to the added advantage of real time visualization of the fistula tract and internal opening of the fistula using a fistuloscope. This is cross sectional study in which 84 patients were selected using consecutive non probability sampling. They underwent VAAFT and were followed to assess for primary healing and continence at 6 weeks, and recurrence at 1 year. In this study, 97.6% participants were male. Mean operating time was 24 minutes while Mean VAS was 3.7±2.2. Healing was observed in 83.2% whereas recurrence was found in 10% at one year. All of the patients had normal sphincteric function post operatively. The results of our study affirm other studies in terms of cure rates, sphincter preservation and fistula recurrence. Studies with larger sample size and long term follow up are required to establish the superiority of VAAFT over the other currently available treatment options for anal fistula.

Predictive Risk Factors of the Conversion from Video-Assisted Treatment of Anal Fistula to Seton Fistulotomy.

Background: To identify the risk factors of converting from video-assisted anal fistula treatment (VAAFT) to seton fistulotomy. Materials and Methods: A total of 180 patients registered to undergo VAAFT between January 2016 and June 2020 at the Erlonglu Hospital. Intraoperative examination of the fistula tract revealed that the patients were assigned to undergo the VAAFT operation and seton fistulotomy. Results: Among 180 patients aged 37 (±10.4) years who underwent intraoperative examination of the fistula tract, 101 completed the standard VAAFT and 79 converted to seton fistulotomy. Univariate analyses revealed that age, necrotic cavity diameter ≥1 cm, scars at the anal entrance, tissue edema, Parks classification, fistula stenosis, and fistula branches were significantly different between the VAAFT and converted groups (P < .05). Multivariate analysis revealed a significant correlation between the risk of surgery conversion and the presence of necrotic cavity with a diameter of ≥1 cm (odds ratio [OR]: 3.668, 95% confidence interval [CI]: 1.366-9.853, P = .01), scars at the anal entrance (OR: 9.462, 95% CI: 1.562-57.32, P = .014), fistula stenosis (OR: 25.14, 95% CI: 5.211-121.3, P < .001), and fistula branches (OR: 2.90, 95% CI: 1.088-7.73, P = .033). The nomogram based on the logistic model was fitted with high accuracy and area under curve of 0.793 (95% CI: 0.726-0.861). Conclusions: The independent risk factors of conversion from surgery for VAAFT to seton fistulotomy were the presence of necrotic cavity with a diameter of ≥1 cm, scars at the anal entrance, fistula stenosis, and fistula branches. The protocol of this systematic review was registered a priori in the Chinese Clinical Trial Registry (ChiCTR) under the registration number of ChiCTR1900022810.