title: Preliminary results of video-assisted anal fistula treatment (VAAFT) in children.
abstract: BACKGROUND
  Anal fistula is a common acquired anorectal disorder in children. Treatment methods that have been used are associated with inconsistent results and possible serious complications. In 2011 a minimally invasive approach, video-assisted anal fistula treatment (VAAFT) was described for adult patients. The aim of the present study was to assess the first series of pediatric patients treated with VAAFT.
  
  
  METHODS
  All patients who underwent VAAFT between August 2013 and May 2015 were included. Demographics, clinical features, preoperative imaging, surgical details, outcome, and medium-term data were prospectively collected for each patient.
  
  
  RESULTS
  Thirteen procedures were performed in nine patients. The male to female ratio was 8:1, and the median age was 9.6 years. Five fistulas were idiopathic, three iatrogenic, and one associated with Crohn's disease. Eight complete VAAFT procedures were performed. The remaining five procedures were either fistuloscopy and cutting seton placement or fistuloscopy and electrocoagulation, both without mucosal sleeve. The median length of surgery was 41 min. The median hospital stay was 24 h, and the median length of follow-up was 10 months. Resolution of the fistula was observed in all patients who underwent a complete VAAFT. In four out of five patients who underwent an incomplete procedure (without mucosal sleeve), the fistula recurred. No incontinence or soiling was reported in the medium term.
  
  
  CONCLUSIONS
  VAAFT proved to be feasible and safe in children. It also proved to be versatile as it could be applied to fistulas of different etiologies. The key to success seems to be an adequate mucosal sleeve. Older children and adolescents benefit most from VAAFT which is a valid alternative to available surgical procedures.
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy. alessiopiniprato@ospedale-gaslini.ge.it.|Department of Cardio-Thoraco-Abdominal Surgery and Transplantation, Unit of Pediatric Surgery, Giannina Gaslini Institute, Largo Gerolamo Gaslini, 5, Genoa, Italy. alessiopiniprato@ospedale-gaslini.ge.it.
authors.forename: A
authors.initials: A
authors.lastname: Pini Prato
authors.affiliation: Unit of Anaesthesia, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Zanaboni
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mosconi
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mazzola
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Muller
authors.affiliation: Department of General Surgery, Proctological Unit, Sestri Levante Hospital, Genoa, Italy.
authors.forename: P C
authors.initials: PC
authors.lastname: Meinero
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.|DINOGMI, University of Genoa, Genoa, Italy.
authors.forename: M G
authors.initials: MG
authors.lastname: Faticato
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.|DINOGMI, University of Genoa, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Leonelli
authors.affiliation: Unit of Anaesthesia, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Montobbio
authors.affiliation: Unit of Anaesthesia, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Disma
authors.affiliation: Department of Surgery, Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.|DINOGMI, University of Genoa, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mattioli
mesh_terms: D000293:Adolescent; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*
keywords: Anal fistula; Crohn’s disease; Minimally invasive approach; Perianale abscess; VAAFT