Abstract
Video-assisted anal fistula treatment (VAAFT) is a fairly new sphincter-saving and minimally invasive surgical technique to treat complex anal fistulas and their recurrences. The main characteristic of the procedure is the direct vision which differentiates it from any other surgical technique. VAAFT makes use of a particular optical device named “Meinero’s Fistuloscope” (manufactured by Karl Storz SE & Co. Kg. – Tuttlingen Germany) which allows to treat the anal fistula from the inside. VAAFT has two phases: diagnostic and operative. Aims of the first phase is to correctly identify the fistula main tract and the fistula internal opening, not forgetting any secondary tracts or abscess cavities, very common condition in complex cases. During the operative phase, all fistula tracts and any possible abscess cavities are destroyed with a monopolar electrode passing through the operative channel of the fistuloscope, always visually. The necrotic material is removed with an endo-brush, here too, under direct vision. This technique has many advantages compared to the other techniques: treating the fistula under vision and from the inside, the risk to damage the sphincter apparatus is nil, no significant wounds are made on the perianal area, the patient doesn’t need painful dressings, and can manage his postoperative period at home. And more, the patient returns to work after a few days. However, the closure of the internal opening remains a weakness. This cannot be done with the fistuloscope. So, in this chapter, I’m showing at least four surgical methods to do it.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adegbola SO, Sahnan K, Pellino G, Tozer PJ et al (2017) Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol 21:775–782
Adegbola SO, Sahnan K, Tozer PJ, Strouhal R, Hart AL, Lung PFC, Phillips RKS, Faiz O, Warusavitarne J (2018) Symptom amelioration in Crohn’s perianal fistulas using video assisted anal fistula treatment (VAAFT). J Crohn’s Colitis 12(9):1067–1072
Emile SJ, Elfeki H, Shalby M, Sakr A (2018) A systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc 32:2084–2093
Garg P, Singh P (2017) Video-assisted anal fistula treatment (VAAFT) in Cryptoglandular fistula-in-ano: a systematic review and proportional meta-analysis. Int J Surg 46:85–91
Jiang HH, Liu HL et al (2017) Video assisted anal fistula treatment (VAAFT) for complex anal fistula: a preliminary evaluation in China. Med Sci Monit 23:2065–2071
Kochhar G, Saha S et al (2014) Video-assisted anal fistula treatment. JSLS 18(3):1–5
Liu H, Tang X, Chang Y et al (2020) Comparison of surgical outcomes between viceo-assisted anal fistula treamente and fistulotomy plus seton for complex anal fistula: a propensity score matching analysis – retrospective chjort study. IntJSurg 75:99–104
Meinero P (2021). Video Assisted-Treatment of Anal Fistula (VAAFT) and Pilonidal Sinus Disease. A concise report on the Meinero’s techniques. Hand to hand manual. ENDO-PRESS. Karl Storz SE Tuttlingen-Germany. p. 11
Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15:417–422
Meinero P, Mori L, G, Gasloli. (2014) Video-assisted anal fistula treatment: a new concept of treating anal fistulas. Dis Colon Rectum 57:354–359
Pini Prato A, Zanaboni C, Mosconi M et al (2016) Preliminary results of video assisted anal fistula treatment (VAAFT) in children. Tech Coloproctol 20(5):279–285
Regusci L et al (2020) Video assisted anal fistula treatment (VAAFT) for complex anorectal fistula. Efficacy and risk factors for failure at three-year follow-up. Tech Coloproctol 24(7):741–746
Rojanasakul A et al (2007) Total anal sphincter saving technique for fistula-in-ano: the ligation of the intersphincteric tract. J Med Assoc Thai 90(3):581–586
Sangwan YP, Rosen L, Riether RD, Stasik JJ, Sheets JA, Khubchandani IT (1994) Is simple fistula-in-ano simple? Dis Colon Rectum 37(9):885–889
Schwandner O (2013) Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn’s disease. Tech Coloproctol 17:221–225
Seow-En I, Seow-Choen F, Koh PK (2016) An experience with video-assisted anal fistula treatment (VAAFT) with new insights into the treatment of anal fistulae. Tech Coloproctol 20(6):389–393
Tozer P, Sahnan K, Adegbola S, Shaikh S, Lung P (2019) Video-assisted anal fistula treatment (VAAFT) assisted seton placement – a video vignette. Color Dis 21(12):1462
Walega P, Romaniszyn M, Nowak W (2014) VAAFT: a new minimally invasive method in the diagnostic and treatment of anal fistula – initial results. Pol Prezegl Chir 86(1):7–10
Yao YB et al (2021) VAAFT plus FiLaC: a combined procedure for complex anal fistula. Tech Coloproctol 25(8):977–979
Zelić M, Karlović D et al (2020) Video-assisted anal fistula treatment for treatment of complex Cryptoglandular anal fistulas with 2 years follow-up period: our experience. J Lap Adv Surg Tech 30(12):1–4
Zheng L, Lu J, Pu Y, Xing C, Zhao K (2018) Comparative study of clinical efficacy between video-assisted anal fistula treatment and traditional fistula resection plus seton in treatment of comples anal fistula. Zhohnghua Wei Chang Way Ke Za Zhi 21(7):793–797
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry
Meinero, P. (2022). VAAFT. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-76670-2_27
Download citation
DOI: https://doi.org/10.1007/978-3-030-76670-2_27
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-76669-6
Online ISBN: 978-3-030-76670-2
eBook Packages: MedicineReference Module Medicine