Giarratano G, Shalaby M, Toscana C, Sileri P
Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy.
Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
Colorectal Dis. 2020 Aug;22(8):939-944. doi: 10.1111/codi.15005. Epub 2020 Feb 27.
This prospective study aimed to evaluate the safety and efficacy of video-assisted anal fistula treatment (VAAFT) in complex fistula-in-ano (FIA).
Consecutive patients presenting with complex FIA were recruited between November 2012 and November 2018. The primary outcome was healing of the fistula.
Seventy-two patients were included, 39 (54%) of whom were men, with a mean age of 46 (±11) years. The mean follow-up was 32 (±18) months. Complete healing was achieved in 64 (89%) patients. When persistent and recurrent cases were considered together, the failure rate was 21% and the success rate 79%. When patients failed, they were offered VAAFT again, after which there was an in increase in the healing rate, which overall (primary and secondary) was 86%. There was no statistically significant deterioration in continence. Eight (11%) patients experienced postoperative complications which required no additional surgical intervention.
VAAFT represents a promising, sphincter-saving technique for the treatment of complex FIA. It has proved efficacious, with 79% of patients achieving complete healing after its primary application. After a second use, this reached 86%. The main advantage of VAAFT compared with other sphincter-saving techniques is working under direct vision. VAAFT has a good safety profile with 11% of patients experiencing minor complications, and there is no effect on continence.
本前瞻性研究旨在评估视频辅助肛瘘治疗（VAAFT）在复杂性肛瘘（FIA）中的安全性和有效性。
2012年11月至2018年11月期间连续纳入患有复杂性FIA的患者。主要结局是肛瘘愈合。
共纳入72例患者，其中39例（54%）为男性，平均年龄46（±11）岁。平均随访时间为32（±18）个月。64例（89%）患者实现完全愈合。将持续性和复发性病例合并考虑时，失败率为21%，成功率为79%。患者失败后，再次接受VAAFT治疗，之后愈合率有所提高，总体（初次和二次）愈合率为86%。控便能力无统计学意义的恶化。8例（11%）患者出现术后并发症，但无需额外手术干预。
VAAFT是一种有前景的保留括约肌的复杂性FIA治疗技术。已证明其有效，79%的患者在初次应用后实现完全愈合。二次应用后，这一比例达到86%。与其他保留括约肌的技术相比，VAAFT的主要优势在于直视下操作。VAAFT安全性良好，11%的患者出现轻微并发症，且对控便能力无影响。
