Minimally invasive video-assisted sphincter-sparing treatment of complex rectal fistulas using the VAAFT technique

Background. Video-assisted anal fistula treatment (VAAFT) is a new minimally invasive sphincter-sparing technology.Objective: to describe technical characteristics of VAAFT and evaluate short-term outcomes.Materials and methods. We used a specialized surgical video system (VAAFT®; Karl Storz) for the treatment of complex high rectal fistulas. This technology allows a surgeon to use a special fistuloscope to perform visual examination of the fistula, find its internal opening, and detect secondary fistula passages and inflows. In addition to visual inspection, it is possible to simultaneously conduct a cytological brush through the working channel of the endoscope in order to clear the fistula from detritus and desquamate lining mucosa, and then perform fistula ablation using a monopolar electrode. The internal opening of the fistula can be either closed by a flap or sutured using a linear stapling device or closed using an endoscopic clip with additional sealing of the suture line with biological glue.Results. Between September 2017 and August 2019, a total of 112 patients underwent VAAFT® surgeries. Ninety-three patients (83 %) were followed up for 6 months postoperatively. We observed no significant complications during the follow-up period. The majority of study participants (85 %) did not experience severe pain (>2–4 points on a visual-analog scale) in the early postoperative period. Primary healing was achieved in 98 patients (87.5 %) within 2–3 months. Eighty-nine individuals (79.5 %) were followed up for more than 1 year. Rectal fistula healing within 1 year after VAAFT® surgery was observed in 82 % of patients.Conclusions. The main advantage of the VAAFT® technique is the combination of the diagnostic stage for fistula visualization and identification of the internal opening with the possibility of simultaneous surgical treatment.

Download Full-text

Efficacy of video-assisted anal fistula treatment combined with closure of the internal opening using a stapler for Parks II anal fistula

Annals of Translational Medicine ◽

10.21037/atm-20-7154 ◽

2020 ◽

Vol 8 (22) ◽

pp. 1517-1517

Author(s):

Yuru Zhang ◽

Fei Li ◽

Tuanjie Zhao ◽

Feng Cao ◽

Yamin Zheng ◽

...

Keyword(s):

Anal Fistula ◽

Internal Opening ◽

Video Assisted ◽

Fistula Treatment

Download Full-text

Video-assisted anal fistula treatment combined with anal fistula plug for treatment of horseshoe anal fistula

Journal of International Medical Research ◽

10.1177/0300060520980525 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098052

Author(s):

Yuru Zhang ◽

Fei Li ◽

Tuanjie Zhao ◽

Feng Cao ◽

Yamin Zheng ◽

...

Keyword(s):

Anal Fistula ◽

Standard Procedure ◽

Cure Rate ◽

Sphincter Function ◽

Anal Sphincter Function ◽

Video Assisted ◽

Fistula Plug ◽

Fistula Healing ◽

Anal Fistula Plug ◽

Fistula Treatment

Objective Horseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for the treatment of horseshoe anal fistula and investigated its efficacy and adverse effects. Methods We retrospectively analyzed the outcomes of video-assisted anal fistula treatment combined with an anal fistula plug (VAAFT-Plug) in 26 patients with a horseshoe anal fistula. The follow-up period ranged from 6 to 18 months. Preoperative and postoperative data were collected to analyze the cure rate, anal sphincter function, and incidence of complications. Results The surgeries were successfully performed in all patients, 23 of whom were cured (effective cure rate of 88.46%). Three patients developed recurrence and were cured after traditional surgery. No patients developed severe complications or postoperative anal incontinence. The VAAFT-Plug protocol was performed with a small incision in the fistula that subsequently promoted fistula healing and preserved sphincter function. Conclusion Although randomized controlled trials will be needed to fully validate these findings, our results suggest that VAAFT-Plug represents a promising treatment strategy for horseshoe anal fistulas. This technique preserves normal anal function and achieves satisfactory outcomes in most patients.

Download Full-text

Role of video assisted anal fistula treatment in our management of fistula-in-ano

Acta chirurgica iugoslavica ◽

10.2298/aci1402083g ◽

2014 ◽

Vol 61 (2) ◽

pp. 83-85 ◽

Cited By ~ 3

Author(s):

Tomáas Grolich ◽

Tomás Skricka ◽

Oldøich Robek ◽

Zdenìk Kala ◽

Beata Hemmelová ◽

...

Keyword(s):

Anal Fistula ◽

Perianal Fistula ◽

Internal Opening ◽

Fistula In Ano ◽

Chronic Fistula ◽

Video Assisted ◽

Seton Drainage ◽

Fistula Treatment ◽

Established Role

Background: Video-assisted anal fistula treatment is a new method used for treatment of complex perianal fistula with maximal sparing of sphincter muscles and prevention of false route. Authors inform about their experience and operative results. Aims: Our aim was to verify feasibility of the method, help in internal opening identification and define its position in our management of perianal fistulas. Methods: Patients with chronic fistula-in-ano of IBD and non-IBD benign etiology were enrolled. Anoscopy with fistuloscopy was attempted in all patients followed by loose seton drainage or other procedure. Results: Fistuloscopy was attempted in 30 patients, finished in 93% and internal opening was found in 67%. No procedure-related morbidity was observed. Conclusion: Fistuloscopy alone is feasible for diagnosing type of IBD and non-IBD fistulas. VAAFT technique and instruments were helpful for identification of an internal opening in most cases. As such it has established role in our management of fistula-in-ano.

Download Full-text

Initial Experience With Video-Assisted Anal Fistula Treatment in the Philippines

Annals of Coloproctology ◽

10.3393/ac.2020.02.28 ◽

2020 ◽

Vol 36 (2) ◽

pp. 112-118

Author(s):

Marc Paul J. Lopez ◽

Mark Augustine S. Onglao ◽

Hermogenes J. Monroy III

Keyword(s):

Postoperative Complications ◽

Anal Fistula ◽

Healing Rate ◽

The Philippines ◽

Invasive Technique ◽

Internal Opening ◽

Video Assisted ◽

Study Results ◽

Fistula Treatment ◽

Opening Method

Purpose: We determined the outcomes of patients undergoing video-assisted anal fistula treatment (VAAFT) for fistulain-ano at the Philippine General Hospital.Methods: Twenty consecutive adult patients who underwent the VAAFT procedure from 2016–2018 were included in this investigation. Information detailing baseline demographic and clinical data, fistula type and classification, and previous surgeries were retrieved from in-hospital and operative records. Operative time, identification of the internal opening, method of internal opening closure, and occurrence of immediate postoperative complications were determined. The status of the fistula was assessed at one month, 3 months, and 6 months postoperatively based on outpatient follow-up records. The primary outcomes were healing rate and recurrence rate. Secondary outcomes were 30-day morbidity, postoperative complications, and incontinence using the Wexner score.Results: Eighteen patients (90%) had a preoperative diagnosis of complex fistula, and 13 patients (65%) had undergone a previous fistula surgery. Primary healing rate was 55% at 1 month, 63.16% at 3 months, and 78.95% at 6 months postoperatively. Eighteen patients (94.74%) maintained continence (Wexner score = 0) at 6 months.Conclusion: Our study results suggest that VAAFT is a safe, minimally invasive technique for treatment of anal fistula and can preserve anal sphincter function. The technique has an acceptable healing rate with minimal complications.

Download Full-text

Video Assisted Anal Fistula Treatment, a Paradigm Shift in the Treatment of Complex Anal Fistulas

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/61 ◽

2021 ◽

Vol 8 (06) ◽

pp. 313-318

Author(s):

Anshu Atreya ◽

Ankit Raikhy ◽

Srinivasa Rao Geddam ◽

Abhishekh Bhartia ◽

Vishnu Kumar Bhartia

Keyword(s):

Anal Fistula ◽

Small Subset ◽

Internal Opening ◽

Anal Fistulas ◽

Fistula In Ano ◽

Video Assisted ◽

Wide Range ◽

Ancient Times ◽

Fistula Treatment ◽

Complex Anal Fistulas

BACKGROUND Fistula-in-ano or anal fistulas are documented since ancient times and their management has always been a challenge. Various modalities of treatment are available and newer ones are being added each day. The aim of this retrospective study is to analyse the outcome of the video assisted anal fistula treatment (VAAFT), one of the modalities of treatment for complex anal fistulas done at our centre. METHODS Records of patients who had been treated through VAAFT by single senior consultant surgeon of Minimal Access Surgery unit between April 2013 and March 2019, were collected and analysed. RESULTS Altogether, records of 48 (forty-eight) patients who had undergone VAAFT during the period were analysed. Data revealed that 38 male (79.17 %) and 10 female (20.83 %) patients with mean age of 49.96 ± 12.22 years were operated. Most commonly, trans sphincteric followed by inter sphincteric type of fistulae were encountered. In 3 cases, internal opening couldn’t be visualised. Six patients were documented to have a recurrence within 6 months of the procedure and in the rest were cured except in a small subset of patients who did not follow up. CONCLUSIONS Amongst the wide range of armamentarium available today for the treatment of complex anal fistulas, video assisted anal fistula treatment (VAAFT) is a novel sphincter saving technique. The recurrence rate at our centre was at par with other studies and with zero incontinence rate, however further RCTs are required. KEYWORDS Complex Anal Fistula, Fistula-in-Ano, MEINERO Fistuloscope, VAAFT

Download Full-text

Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000100018 ◽

2014 ◽

Vol 27 (1) ◽

pp. 77-81 ◽

Cited By ~ 12

Author(s):

Carlos Ramon Silveira MENDES ◽

Luciano Santana de Miranda FERREIRA ◽

Ricardo Aguiar SAPUCAIA ◽

Meyline Andrade LIMA ◽

Sergio Eduardo Alonso ARAUJO

Keyword(s):

Anal Fistula ◽

Fistula Tract ◽

Anorectal Fistula ◽

Treatment Technique ◽

Internal Opening ◽

Direct Closure ◽

Invasive Approach ◽

Internal Fistula ◽

Video Assisted ◽

Fistula Treatment

Backgroung : Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment. Aim : To describe the technique and initial experience with the technique video-assisted for anal fistula treatment. Technique : A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture. Results : The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient. Conclusion : Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

Download Full-text

A Video-Assisted Anal Fistula Treatment (VAAFT): A New Minimally Invasive Treatment Option for Fistula in Ano

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i29a31571 ◽

2021 ◽

pp. 135-139

Author(s):

Nawaz Ali Dal ◽

Arshad Hussain Abro ◽

Muhammad Anwar Memon ◽

Ahmer Akbar Memon ◽

Muhammad Qasim Mallah ◽

...

Keyword(s):

Minimally Invasive ◽

Anal Fistula ◽

Treatment Option ◽

Complete Healing ◽

Minimally Invasive Treatment ◽

General Surgeon ◽

Invasive Treatment ◽

Fistula In Ano ◽

Video Assisted ◽

Fistula Treatment

Objective: To determine the outcome of video-assisted anal fistula treatment (VAAFT): A new minimally invasive treatment option for fistula in ano. Study Design: This is an observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form January 2020 to June 2020. Material & Method: Inclusion criteria for this study were patients aged 18-60 years visiting the outpatient department with primary/recurrent fistula having symptoms. Among these individuals having anal fistula due to secondary causes like IBD, tuberculosis or any malignancy were not included in the study. VAAFT was performed by experience general surgeon and post-operative follow up was done till 1 years. Results: A total of 68 patients with fistula in ano were selected for video assisted anal fistula treatment (VAAFT) in our setup. It included 67.6% (n=46) males and 32.3% (n=22) females who agreed for the procedure. The mean age of patients were found to be 43+13 years. Post-operatively complete healing was observed in 75% (n=51) patients and 14.7% patients had persistent fistula after the procedure. Conclusion: VAAFT is a minimally invasive surgical intervention implied to treat primary and recurrent anal fistulas, having lesser rates of recurrence and few post-operative complications. It should be implied over large scales for treatment of primary and recurrent anal fistula as it carries the lowest rate of anal incontinence.

Download Full-text