Our Summary

This research paper discusses the use of a technique called Video-Assisted Anal Fistula Treatment (VAAFT) in treating a painful anal condition known as perianal fistula. This condition can either be primary (first time occurrence) or recurrent (repeated occurrence).

The study was carried out between November 2011 and March 2014 and involved 224 patients, some with a primary fistula and others with a recurrent fistula. The researchers monitored the patients’ recovery process, including any complications during and after the surgery, and the overall healing rate.

The study found that the VAAFT technique was very effective in treating both primary and recurrent fistula. Within three months of surgery, 77% of patients with a primary fistula were completely healed. This rate increased to 92.3% when considering patients who had a second VAAFT due to a recurrent fistula.

For patients with a recurrent fistula, 64% achieved primary healing within three months of surgery, which increased to 80.2% after 12 months. Only a small number of patients needed painkillers after the surgery, and all patients were able to get back to their daily activities within a week of their surgery.

The researchers concluded that VAAFT is a safe and effective way to treat anal fistulas, with high healing rates and a quick return to normal activities. However, they also acknowledged that the study was limited by being retrospective (looking back on past events) and being carried out at only one center.

FAQs

  1. What is Video-Assisted Anal Fistula Treatment (VAAFT) and what conditions does it treat?
  2. What were the healing rates for patients with primary and recurrent fistulas after undergoing VAAFT?
  3. Did the researchers identify any limitations to their study on the effectiveness of VAAFT in treating anal fistulas?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to carefully follow post-operative care instructions to ensure proper healing. This may include keeping the area clean, avoiding strenuous activities, and taking any prescribed medications as directed. It is also important to attend follow-up appointments with your healthcare provider to monitor your progress and address any concerns. By following these recommendations, you can help promote a successful recovery and minimize the risk of complications.

Suitable For

Typically, patients who are recommended for anal fistula surgery are those who have been diagnosed with a perianal fistula that is causing significant pain, discomfort, and/or recurrent infections. Patients who have tried conservative treatments such as antibiotics, sitz baths, and drainage procedures without success may also be recommended for surgery.

Additionally, patients with complex or multiple fistulas, as well as those with underlying conditions such as Crohn’s disease or immunodeficiency, may also be candidates for surgery. It is important for patients to discuss their symptoms and medical history with their healthcare provider to determine if surgery is the appropriate treatment option for their specific case.

Timeline

Overall, the timeline for a patient before and after anal fistula surgery would involve:

Before surgery:

  • Experiencing symptoms such as pain, swelling, discharge, and difficulty with bowel movements
  • Consulting with a doctor to diagnose the anal fistula and discuss treatment options
  • Undergoing tests such as a physical exam, MRI, or ultrasound to determine the extent of the fistula
  • Preparing for surgery by following any pre-operative instructions provided by the doctor

After surgery:

  • Recovering in the hospital for a few hours to a day, depending on the complexity of the surgery
  • Managing pain and discomfort with prescribed medications
  • Following post-operative care instructions, such as keeping the surgical area clean and dry, taking sitz baths, and avoiding strenuous activities
  • Attending follow-up appointments with the doctor to monitor healing progress and address any concerns
  • Returning to normal activities gradually as healing progresses, typically within a week to a month after surgery

Overall, anal fistula surgery can provide relief from symptoms and improve quality of life for patients, with a high success rate and minimal complications when performed using techniques like VAAFT.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery, particularly if considering VAAFT, may include:

  1. What is the success rate of VAAFT for treating anal fistulas, particularly in cases of primary or recurrent fistulas?
  2. What are the potential complications or risks associated with VAAFT surgery?
  3. How long is the recovery period after VAAFT surgery, and when can I expect to return to normal activities?
  4. Will I need any follow-up appointments or treatments after the surgery?
  5. Are there any specific post-operative care instructions I should follow to ensure optimal healing?
  6. How experienced is the surgeon in performing VAAFT procedures, and what is their success rate with this technique?
  7. Are there any alternative treatment options for anal fistulas that I should consider?
  8. What is the likelihood of the anal fistula recurring after VAAFT surgery?
  9. Will I need to make any lifestyle changes or adjustments after the surgery to prevent future anal fistulas?
  10. Are there any specific dietary or hygiene recommendations I should follow to support healing and prevent complications?

Reference

Authors: Stazi A, Izzo P, D’Angelo F, Radicchi M, Mazzi M, Tomassini F, Izzo L, Valabrega S. Journal: Minerva Chir. 2018 Apr;73(2):142-150. doi: 10.23736/S0026-4733.18.07390-X. Epub 2018 Jan 23. PMID: 29366306