Our Summary

This research paper is about a study conducted to test the safety and effectiveness of a treatment method called Video-Assisted Anal Fistula Treatment (VAAFT) for a medical condition known as complex fistula-in-ano (FIA). This condition involves an abnormal connection between the skin near the anus and the rectum, which can be difficult to treat.

The study involved 72 patients, and it was observed over a period of six years. The main goal was to see if the fistulas (the abnormal connections) healed after the treatment. It was found that 89% of patients experienced complete healing. If we consider cases where the fistula persisted or came back, the treatment was successful 79% of the time. However, if a patient didn’t improve after the first treatment, they were offered the treatment again, and this increased the healing rate to 86%.

The study found that the treatment did not negatively impact the patients’ control over bowel movements, which is a major advantage. There were complications in 11% of the cases, but these were minor and didn’t require any additional surgery.

In conclusion, the study suggests that VAAFT is a promising treatment method for complex FIA. One major benefit is that the treatment allows doctors to work under direct vision, meaning they can see what they’re doing more clearly. The treatment also has a good safety record and doesn’t affect bowel control.

FAQs

  1. What is the success rate of video-assisted anal fistula treatment (VAAFT) in treating complex fistula-in-ano?
  2. What are the potential postoperative complications of VAAFT and how common are they?
  3. Does VAAFT treatment have any effect on continence?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions carefully to ensure proper healing. This may include keeping the area clean, avoiding strenuous activities, and taking prescribed medications as directed. It is also important to attend follow-up appointments to monitor healing progress and address any concerns.

Suitable For

Patients with complex fistula-in-ano (FIA) are typically recommended for anal fistula surgery, specifically video-assisted anal fistula treatment (VAAFT). Complex FIA refers to fistulas that are associated with multiple tracts, high intersphincteric or suprasphincteric extensions, or previous failed treatments. These patients may have a higher risk of recurrence or complications with conventional treatments, making VAAFT a suitable option for their condition. Additionally, patients who desire a sphincter-saving technique or wish to avoid the risk of incontinence may benefit from VAAFT surgery.

Timeline

Before anal fistula surgery:

  • Patient experiences symptoms such as pain, swelling, discharge, and abscess formation in the anal area
  • Patient undergoes a physical examination and possibly imaging tests to diagnose the anal fistula
  • Treatment options, including VAAFT, are discussed with the patient
  • Patient may need to undergo preoperative preparation such as bowel cleansing

After anal fistula surgery:

  • Patient undergoes VAAFT procedure under direct vision
  • Healing of the fistula is monitored during follow-up appointments
  • If the fistula does not heal completely, patient may undergo a second VAAFT procedure
  • Overall, 79% of patients achieve complete healing after the primary VAAFT application, with an increase to 86% after a second use
  • Patient may experience minor postoperative complications, but there is no significant effect on continence
  • Long-term follow-up is recommended to monitor for any recurrence or complications

What to Ask Your Doctor

  1. What is the success rate of VAAFT in treating complex fistula-in-ano?
  2. How does VAAFT compare to other surgical techniques for treating anal fistulas?
  3. What are the potential risks and complications associated with VAAFT surgery?
  4. How long is the recovery time after VAAFT surgery?
  5. Will I experience any changes in bowel function or continence after VAAFT surgery?
  6. Are there any lifestyle changes or dietary modifications I should make post-surgery?
  7. What is the likelihood of the fistula recurring after VAAFT surgery?
  8. How many VAAFT procedures may be needed to achieve complete healing?
  9. What is the long-term prognosis for patients who undergo VAAFT surgery?
  10. Are there any alternative treatment options for complex fistula-in-ano if VAAFT is not successful?

Reference

Authors: Giarratano G, Shalaby M, Toscana C, Sileri P. Journal: Colorectal Dis. 2020 Aug;22(8):939-944. doi: 10.1111/codi.15005. Epub 2020 Feb 27. PMID: 32030874