P014 Video assisted anal fistula treatment (VAAFT): A 5 year review

Published Date: 06th September 2022

Publication Authors: Alfred J, Santoro G, Beggs R, Brookes J, Rajaganeshan R

Aim
VAAFT is claimed to be the only technique that allows the surgeon to see inside the anal fistula tract and locate the internal opening using an endoscope light. It is designed to only affect the fistula tract and there preserve sphincter function and faecal continence. Our aim was to have a 5 year review of the follow up patients who we treated with VAAFT.

Method
A review of outcomes for 5 years following VAAFT procedure was conducted. The patients where treated with VAAFt from November 2014 to February 2017. Wexner score for obstructed defecation syndrome was used to gain outcomes for patients who had faecal incontinence. An analysis was done of pre and post VAAFT procedure on the outcome of the patients quality of life and a visual analogue on subjective characteristics or attitudes post VAAFT was enquired of the patients on there follow up interview on the procedure.

Results
50 patients where included in this follow up period, 42% and 58% where female and male respectively. The median age was 52 years and this ranged from 24 to 76 years. 30% of patients had an ASA grade of 1, 58% had an ASA grade of 2 and 6 patients had an ASA grade of 6. 84% of patients have been cured after the VAAFT procedure, with 74% being cured after only 1 VAAFT procedure. Only 5 patients are still symptomatic with anal fistulas, but there symptoms are reduced enough for them not to want any further procedures at this point. 3 patients are awaiting further VAAFT procedure that has been delayed due to COVID.

Conclusion
This novel sphincter preserving technique has promising early results after 5 years. This raises a few further questions such as should we adapt to hybrid procedures with VAAFT? what is the role of setons in the treatment with VAAFT, is their use in the acute setting with sepsis? A large study with long term follow up is awaited. The need to maintain a prospective regional/national registry to see the true benefit of VAAFT procedure.

 

Alfred, J; Santoro, G; Beggs, R; Brookes, J; Rajaganeshan, R. (2022). P014 Video assisted anal fistula treatment (VAAFT): A 5 year review. Colorectal Disease. 24(Suppl 3), p.53. [Online]. Available at: https://onlinelibrary.wiley.com/doi/10.1111/codi.16276 [Accessed 6 January 2023]

 

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