Video-assisted anal fistula treatment

JSLS. Jul-Sep 2014;18(3):e2014.00127. doi: 10.4293/JSLS.2014.00127.

Abstract

Background and objectives: Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. The latest addition to the list of treatment options is video-assisted anal fistula treatment (VAAFT). It is a minimally invasive, sphincter-saving procedure with low morbidity. The aim of our study was to compare the results with a premier study done previously.

Methods: The procedure involves diagnostic fistuloscopy and visualization of the internal opening, followed by fulguration of the fistulous tract and closure of the internal opening with a stapling device or suture ligation. The video equipment (Karl Storz, Tuttlingen, Germany) was connected to an illuminating source.

Results: The study was conducted from July 2010 to March 2014. Eighty-two patients with fistula in ano were operated on with VAAFT and were followed up according to the study protocol. The recurrence rate was 15.85%, with recurrences developing in 13 cases. Postoperative pain and discomfort were minimal.

Conclusion: VAAFT is a minimally invasive procedure performed under direct visualization. It enables visualization of the internal opening and secondary branches or abscess cavities. It is a sphincter-saving procedure and offers many advantages to patients. Our initial results with the procedure are quite encouraging.

Keywords: Fistula in ano; Fistuloscopy; Sphincter-saving surgery; Video-assisted anal fistula treatment (VAAFT); Visual analog score (VAS).

MeSH terms

  • Adult
  • Electrocoagulation / methods*
  • Female
  • Humans
  • Male
  • Rectal Fistula / surgery*
  • Surgical Stapling / methods
  • Treatment Outcome
  • Video-Assisted Surgery / methods*