Ajay H Bhandarwar, MS, Eham L Arora, Saurabh S Gandhi, MS, Chintan B Patel, MS, Amol N Wagh, MS, Priyank D Kothari. Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
Introduction: Fistulas in ano consist of epithelialized tracts between the ano-rectal canal & the external (usually perianal) skin. In spite of their prevalance, no surgical intervention has been hailed a gold standard in their treatment. Therefore, treatment relies greatly on the surgeon's correct assessment & astute judgment. Traditional Fistulotomy & Fistulectomy are associated with significant risk of sphincter injury causing anal incontinence. Video Assisted Anal Fistula Treatment (VAAFT) is a novel endoscopic technique which is unique in allowing direct visualization of fistula tracts.
Materials & Methods: All cases of fistula in ano were subjected to pre-operative Magnetic Resonance or Ultrasonographic Fistulography. Those found to have complex fistulas with multiple branching tracts were eliminated from the study group. VAAFT scope is introduced via the external opening & instillation of normal saline serves to maintain patency of the tract during surgery. The internal opening is identified & closed with either stapler within the anal canal or under-running with Polyglactin sutures. The tract is visualized in its entirely & any secondary tracts if present, are identified. The tract is debrided with a brush introduced via the scope's working channel & the wall cauterized with the help of a spherical tip electro-cautery probe. A tissue sealant glue is introduced at the end of procedure after scope has been removed. Patients were followed up for a minimum of 3 months post-operatively & were assessed for discomfort, pain & incontinence.
Results: 30 patients within the series were evaluated. Mean hospital stay was 2 days with 21 cases complaining of post-op discomfort for 3 days post-procedure. 26 patients returned to work 1 week after surgery which is considerable improvement when compared with traditional surgical options. 4 cases were discovered to have secondary tracts intra-operatively which were not noted in pre-operative imagine. Of these 4, 3 cases developed recurrent discharge, which were given a successful trial of conservative management. No patient within the study group complained of incontinence post-procedure.
Conclusion: VAAFT is unique in allowing the surgery to be performed under direct endoluminal vision. Thus there is greater accuracy in identifying secondary tracts & the internal opening correctly, offering the opportunity to corroborate visualized tract with pre-operative imaging studies. Due to minimal damage to surrounding structures, VAAFT is truly the preeminent sphincter saving surgical option. The procedure is associated with reduced morbidity & better patient acceptance.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80002
Program Number: P619
Presentation Session: Poster (Non CME)
Presentation Type: Poster