Our Summary

This research paper is about a new minimally invasive method for treating complex anal fistulas known as Video-Assisted Anal Fistula Treatment (VAAFT). From 2014 to 2019, 59 patients with this condition were treated with VAAFT. A piece of special video equipment was used to see the fistula (a small channel that has formed between the end of the bowel and the skin near the anus) and close it.

The external opening was kept open and dressed. The patients were then observed for about 59.5 months on average. 67.9% of the patients healed without needing any further treatment, while 12.5% healed but then had a recurrence, and 19.6% did not heal.

For those who didn’t initially heal or had a recurrence, the procedure was repeated, resulting in healing in most of these cases. The average surgery time was 41.1 minutes, and there were no major complications or impacts on continence (the ability to control bowel movements).

Three patients were lost to follow up. The study concludes that VAAFT is both safe and effective for treating complex anal fistulas. If the fistula persists or recurs, the procedure can be repeated with minimal negative effects and a good chance of success.

FAQs

  1. What is Video-Assisted Anal Fistula Treatment (VAAFT)?
  2. What percentage of patients healed without needing any further treatment after the VAAFT procedure?
  3. What happens if the fistula persists or recurs after the VAAFT procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions closely to promote healing and prevent complications. This may include keeping the area clean and dry, taking prescribed medications as directed, and avoiding activities that could strain the surgical site. It is also important to attend follow-up appointments to monitor healing progress and address any concerns.

Suitable For

Patients with complex anal fistulas, which are often recurrent or have multiple tracts, are typically recommended anal fistula surgery. These patients may have tried other conservative treatments such as antibiotics, fistulotomy, or seton placement without success. They may also experience symptoms such as pain, discharge, and recurrent infections due to the fistula.

In the study mentioned above, the patients who underwent VAAFT had complex anal fistulas that were not responding to other treatments. The procedure was successful in the majority of cases, with a high rate of healing and low rates of recurrence. This suggests that VAAFT may be a good option for patients with complex anal fistulas who have not had success with other treatments.

Overall, patients who are experiencing symptoms related to a complex anal fistula and have not responded to conservative treatments may be good candidates for anal fistula surgery, such as VAAFT. It is important for these patients to discuss their options with a healthcare provider to determine the best course of treatment for their individual situation.

Timeline

  • Before surgery: Patients likely experience symptoms such as pain, swelling, discharge, and discomfort in the anal area. They may have already tried conservative treatments such as antibiotics and drainage procedures without success.

  • During surgery: The patient undergoes the VAAFT procedure, where a special video device is used to visualize and close the fistula. The external opening is left open and dressed.

  • After surgery: The patient is monitored for healing, with the majority of patients (67.9%) experiencing successful closure of the fistula without needing further treatment. Some patients (12.5%) may have a recurrence, while others (19.6%) may not heal initially.

  • If needed: Patients who do not initially heal or experience a recurrence may undergo a repeat VAAFT procedure, which has shown good success rates. The average surgery time is relatively short at 41.1 minutes, with no major complications or impact on continence reported.

  • Long-term follow-up: Patients are monitored for an average of 59.5 months, with the study concluding that VAAFT is a safe and effective treatment for complex anal fistulas. The procedure can be repeated if necessary, with minimal negative effects and a good chance of success.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery using the VAAFT method include:

  1. What is a complex anal fistula and how is it different from a simple anal fistula?
  2. How does the Video-Assisted Anal Fistula Treatment (VAAFT) procedure work to treat anal fistulas?
  3. What are the potential risks and complications associated with VAAFT surgery?
  4. What is the success rate of VAAFT in treating complex anal fistulas?
  5. How long is the recovery time after VAAFT surgery?
  6. Will I need to undergo any additional treatments or procedures if the fistula does not heal or recurs after VAAFT surgery?
  7. Are there any lifestyle changes or precautions I should take after VAAFT surgery to prevent a recurrence of the fistula?
  8. How often will I need to follow up with my doctor after VAAFT surgery?
  9. Are there any long-term side effects or impacts on bowel function associated with VAAFT surgery?
  10. Are there any alternative treatment options for complex anal fistulas that I should consider?

Reference

Authors: Hinksman M, Naidu S, Loon K, Grundy J. Journal: ANZ J Surg. 2022 May;92(5):1132-1136. doi: 10.1111/ans.17451. Epub 2022 Jan 10. PMID: 35014148