title: Video-assisted anal fistula treatment: technical considerations and preliminary results of the first Brazilian experience.
abstract: BACKGROUND
  Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment.
  
  
  OBJECTIVE
  To describe the technique and initial experience with the technique video-assisted for anal fistula treatment.
  
  
  METHODS
  A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture.
  
  
  RESULTS
  The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient.
  
  
  CONCLUSIONS
  Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.
authors.affiliation: Hospital Santa Izabel, Santa Casa de Misericordia da Bahia, Salvador, BA, Brazil.
authors.forename: Carlos Ramon Silveira
authors.initials: CR
authors.lastname: Mendes
authors.affiliation: Hospital Santa Izabel, Santa Casa de Misericordia da Bahia, Salvador, BA, Brazil.
authors.forename: Luciano Santana de Miranda
authors.initials: LS
authors.lastname: Ferreira
authors.affiliation: Hospital Santa Izabel, Santa Casa de Misericordia da Bahia, Salvador, BA, Brazil.
authors.forename: Ricardo Aguiar
authors.initials: RA
authors.lastname: Sapucaia
authors.affiliation: Hospital Santa Izabel, Santa Casa de Misericordia da Bahia, Salvador, BA, Brazil.
authors.forename: Meyline Andrade
authors.initials: MA
authors.lastname: Lima
authors.affiliation: Hospital Santa Izabel, Santa Casa de Misericordia da Bahia, Salvador, BA, Brazil.
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araujo
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000295:instrumentation