Video-assisted anal fistula treatment: A single-center experience to opt the right tract

• Main Authors: M Suyambu Raja, Anoop Vasudevan Pillai, Riju Ramachandran
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Formosan Journal of Surgery
• Subjects: fistula in ano; proctology; surgical procedures
• Online Access: http://www.e-fjs.org/article.asp?issn=1682-606X;year=2020;volume=53;issue=6;spage=211;epage=215;aulast=Raja

Background: Fistula-in-Ano is common in clinical practice and is notorious for morbidity and recurrence with current treatment options. Minimal invasive procedure is being tried with encouraging results. Materials and Methods: This is a series of 35 patients who underwent video-assisted anal fistula treatment (VAAFT) in our institution from 2015 to 2018. All patients were evaluated both clinically and with magnetic resonance imaging to delineate the details of the fistula. Patients were treated by VAAFT and followed up for 12 months. The data were acquired from the hospital information system. Failure of the procedure, recurrence, and any other adverse events were recorded correlating it with the gender, comorbidity, type of the tract, linearity of the tract, and relation to the levator ani muscle. Chi-square test with continuity correction was used to find the association between recurrence and clinical parameters. Kruskal–Wallis test was used to compare the mean recurrence time among the type of fistula and tract. Results: In the 27 males and 8 females, we found 22 patients had linear fistulous tract, 6 had linear bifurcated, curvilinear tract in 6, and 1 had a blind tract. The median operation time was 58 min. Healing rate was highest (72.7%) in patients who had a linear tract, and recurrence was highest (66.7%) in patients who had a curvilinear tract. Patients with blind tracts or multiple tracts identified at the surgery and those with Crohn's disease had a higher incidence of recurrence. Conclusion: VAAFT can be recommended as an initial minimally, morbid, though expensive procedure in the management of the simple type of fistula-in-ano with an acceptable recurrence rate.