Department of General Surgery, EOC-Beata Vergine Hospital, Mendrisio, Switzerland.
Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland.
Tech Coloproctol. 2020 Jul;24(7):741-746. doi: 10.1007/s10151-020-02213-w. Epub 2020 Apr 21.
The aim of this study was to assess the 3-year objective and subjective outcomes of patients with complex anorectal fistula treated with Video-Assisted Anal Fistula Treatment (VAAFT). Furthermore, we evaluated the risk factors associated with recurrence.
All consecutive patients with complex anorectal fistula who underwent VAAFT in Beata Vergine Hospital of Mendrisio, Switzerland, from January 2013 to January 2016, were enrolled. Patients with suspicion or diagnosis of Crohn's disease, malignancy, previous history of radiotherapy or radical pelvic surgery were excluded. Preoperative clinical assessment based upon medical history, physical examination and endosonography, was performed in all patients. Data regarding subjective outcomes (the Patient Global Impression of Improvement, patient satisfaction scores and Wexner score), objective cure rate (absence of fistula at clinical examination), and adverse events were collected during follow-up. Uni and multivariate analysis were performed to investigate outcomes.
One hundred and four patients had VAAFT. At 3-year follow-up, 96 patients (92.3%) were available for the evaluation. At 3 years after surgery, 81 of 96 patients (84.4%) declared themselves cured (p = 0.60). Similarly, at 3-year evaluation, 80 of 96 patients (83.3%) were objectively cured (p = 0.52). No serious intraoperative or postoperative complications were reported. All recurrences were treated with a repeat VAAFT procedure resulting in a complete healing. Uni and multivariate analysis of variables potentially involved in the failure of VAAFT showed that age ≥ 50 years was the only factor associated at risk of recurrence.
VAAFT is a highly effective safe procedure for the treatment of anorectal fistula, with a low recurrence rate at 3-year follow-up. However, our study demonstrated that age ≥ 50 years is a risk factor for failure of VAAFT.
本研究旨在评估接受视频辅助肛门瘘管治疗（VAAFT）的复杂肛门瘘患者的 3 年客观和主观结果。此外，我们评估了与复发相关的风险因素。
2013 年 1 月至 2016 年 1 月，瑞士梅德里西奥比泰娃吉纳医院对所有接受 VAAFT 的复杂肛门瘘患者进行了前瞻性研究。排除怀疑或诊断为克罗恩病、恶性肿瘤、既往放疗或根治性盆腔手术史的患者。所有患者均进行了基于病史、体格检查和内镜超声的术前临床评估。在随访期间收集了主观结果（患者整体改善印象、患者满意度评分和 Wexner 评分）、客观治愈率（临床检查无瘘）和不良事件的数据。进行了单因素和多因素分析以探讨结果。
104 例患者接受了 VAAFT。3 年随访时，96 例患者（92.3%）可进行评估。术后 3 年，96 例患者中有 81 例（84.4%）自述治愈（p=0.60）。同样，在 3 年评估时，96 例患者中有 80 例（83.3%）客观治愈（p=0.52）。未报告术中或术后严重并发症。所有复发患者均采用重复 VAAFT 治疗，完全治愈。VAAFT 失败相关潜在变量的单因素和多因素分析显示，年龄≥50 岁是唯一与复发风险相关的因素。
VAAFT 是一种治疗肛门瘘的高效、安全的方法，3 年随访时复发率低。然而，我们的研究表明，年龄≥50 岁是 VAAFT 失败的一个危险因素。
