Our Summary

This research paper discusses the use of a minimally invasive procedure called Video-Assisted Anal Fistula Treatment (VAAFT) for complex anal fistulas. An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. A complex anal fistula (CAF) is a particularly severe or difficult-to-treat case. This study looked back at patients who were treated with VAAFT between 2016 and 2019.

The patients were either treated with the aim to heal the fistula (if the internal opening was closed at the time of the procedure), or received a more diagnostic or palliative VAAFT if there was no complete treatment, or if only part of the fistula was treated.

After the procedure, the researchers checked how the patients were doing. Out of the 84 patients, 19 healed completely. However, 34 patients who did not heal completely, reported that their symptoms had improved. On the other hand, 23 patients reported no improvement, and 6 patients said their symptoms got worse.

Also, 16 patients who had CAF for more than 5 years did not fully heal, though half of them reported symptom improvement. Five patients suffered from fecal incontinence (lack of control over bowel movements) after the procedure, but this was managed conservatively.

In conclusion, VAAFT can be a good option for complex fistula cases when there are no other minimally invasive options available. However, complete healing is rare, and while it can help improve symptoms for some patients, there is a small risk of incontinence.

FAQs

  1. What is Video-Assisted Anal Fistula Treatment (VAAFT) and how is it used in treating complex anal fistulas?
  2. What were the results of the study on patients treated with VAAFT between 2016 and 2019?
  3. What are the potential risks and benefits of using VAAFT for complex anal fistula cases?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery, particularly VAAFT, is to be prepared for the possibility of not achieving complete healing. While the procedure can improve symptoms for some patients with complex anal fistulas, complete healing is rare. It’s important to have realistic expectations and to discuss any concerns or potential risks with your healthcare provider before undergoing the surgery. Additionally, it’s important to follow post-operative care instructions carefully to optimize healing and minimize complications.

Suitable For

Patients who are typically recommended anal fistula surgery are those with complex anal fistulas that have not responded to other treatments such as medications or less invasive procedures. These patients may experience symptoms such as persistent pain, discharge, and recurrent infections. Additionally, patients who have had the anal fistula for an extended period of time, such as more than 5 years, may be recommended for surgery due to the likelihood of the fistula becoming more severe over time. Overall, surgery may be recommended for patients with complex anal fistulas who have not achieved satisfactory results with conservative treatment options.

Timeline

Before anal fistula surgery:

  1. Patient experiences symptoms such as pain, swelling, discharge, and difficulty passing stools.
  2. Patient undergoes a physical examination and possibly imaging tests to diagnose the anal fistula.
  3. Treatment options are discussed with the patient, including minimally invasive procedures like VAAFT.

After anal fistula surgery:

  1. Patient undergoes VAAFT procedure to treat the anal fistula.
  2. Patient may experience post-operative pain, swelling, and discomfort.
  3. Follow-up appointments are scheduled to monitor healing progress and manage any complications.
  4. Some patients may experience complete healing of the fistula, while others may experience symptom improvement or no improvement.
  5. Some patients may develop fecal incontinence as a complication of the surgery, which can be managed conservatively.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery, specifically regarding Video-Assisted Anal Fistula Treatment (VAAFT), include:

  1. What is the success rate of VAAFT for treating complex anal fistulas?
  2. What are the potential risks and complications associated with VAAFT?
  3. How long is the recovery period after VAAFT surgery?
  4. Will I need any follow-up procedures or treatments after VAAFT?
  5. What are the chances of the fistula recurring after VAAFT?
  6. Are there any alternative treatment options for complex anal fistulas?
  7. How will VAAFT affect my bowel function and continence?
  8. What can I expect in terms of pain management during and after the procedure?
  9. How experienced is the surgeon in performing VAAFT procedures?
  10. Are there any lifestyle changes or precautions I should take after VAAFT surgery to optimize healing and prevent complications?

Reference

Authors: Chase TJG, Quddus A, Selvakumar D, Cunha P, Cuming T. Journal: Tech Coloproctol. 2021 Oct;25(10):1115-1121. doi: 10.1007/s10151-021-02492-x. Epub 2021 Jul 27. PMID: 34318362