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VAAFT for complex anal fistula: a useful tool, however, cure is unlikely

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Abstract

Background

Therapeutic options for complex anal fistula (CAF) are limited. Video-assisted anal fistula treatment (VAAFT) allows examination of these anatomically complex fistulae from within. The aim of the present study was to evaluate outcomes of VAAFT for a series of CAF.

Methods

A retrospective study was conducted on consecutive patients at a single centre with complex anal cryptoglandular and Crohn’s fistulae managed with VAAFT from June 2016 to June 2019. CAF was diagnosed as high intersphincteric/transsphincteric tract, multiple/secondary tracts, horseshoe or anovaginal fistulae. Patients were treated with ‘therapeutic intent’ if the internal opening was closed at the time of ablation and ‘diagnostic/staged/palliative’ VAAFT if there was no ablation/partial treatment/ablation-only, respectively. Symptom improvement was a reduction in reported pain, discharge, or pad use.

Results

Eighty-four patients (73 cryptoglandular, 11 Crohn’s, M:F 2.5:1, median age 43 [22–77] years), underwent 105 VAAFT procedures. Twenty patients had > 1 VAAFT. Median follow-up was 8 (1–46) months. 40 (48%) had multiple or secondary tracts; an additional 16 (19%) had horseshoe and 3 (4%) anovaginal fistulae. Of the 84 patients, 19 [16/73 (22%) cryptoglandular and 3/11 (27%) Crohn’s fistulae] healed. 34 (40%) unhealed reported improved symptoms; 23 (27%) no improvement; and 6 (7%) were worse. Sixteen (19%) had CAF > 5 years of whom none healed, albeit 50% reported symptom improvement. Five patients (6%) developed faecal incontinence: 2 temporary, 1 to flatus only and 1 to liquid and 1 to solid, all managed conservatively.

Conclusions

VAAFT is a useful minimally invasive procedure for complex fistula with no other minimally invasive options. Complete healing is rare, and, although symptoms can be improved in a number of cases, there is a small risk of incontinence.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors would like to thank our gastrointestinal radiology colleagues Dr Peter Boavida and Dr Kamini Patel for their expertise.

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Author notes

  1. T. J. G. Chase and A. Quddus Joint first-authors.

Authors and Affiliations

  1. Colorectal Surgery, Homerton University Hospital, London, UK

    T. J. G. Chase, A. Quddus & T. Cuming

  2. General Surgery, Stepping Hill Hospital, Manchester, UK

    D. Selvakumar

  3. General Surgery, University Hospital Hairmyres, Glasgow, UK

    P. Cunha

Authors
  1. T. J. G. Chase
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  2. A. Quddus
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  3. D. Selvakumar
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  4. P. Cunha
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  5. T. Cuming
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Contributions

All authors have made substantial contributions to the conception and analysis of the work. They have all been involved in the drafting or revising of the work and have approved the final version for publication. They all agree to be accountable for all aspects of the work.

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Correspondence to T. J. G. Chase.

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The authors declare no potential conflicts of interest.

Ethical standards

This study was registered within the Trust as an audit (Ref. Number 2255-3833) and approval was gained from the data protection officer. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Chase, T.J.G., Quddus, A., Selvakumar, D. et al. VAAFT for complex anal fistula: a useful tool, however, cure is unlikely. Tech Coloproctol 25, 1115–1121 (2021). https://doi.org/10.1007/s10151-021-02492-x

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