title: An experience with video-assisted anal fistula treatment (VAAFT) with new insights into the treatment of anal fistulae.
abstract: BACKGROUND
  The aim of this retrospective study was to assess our experience of 41 patients with anal fistulae treated with video-assisted anal fistula treatment (VAAFT).
  
  
  METHODS
  Forty-one consecutive patients with cryptoglandular anal fistulae were included. Patients with low intersphincteric anal fistulae or those with gross perineal abscess were excluded. Eleven (27 %) patients had undergone prior fistula surgery with 5 (12 %) having had three or more previous operations.
  
  
  RESULTS
  All patients underwent the diagnostic phase as well as diathermy and curettage of the fistula tracts during VAAFT. Primary healing rate was 70.7 % at a median follow-up of 34 months. Twelve patients recurred or did not heal and underwent a repeat VAAFT procedure utilising various methods of dealing with the internal opening. There was a secondary healing rate of 83 % with two recurrences. Overall, stapling of the internal opening had a 22 % recurrence rate, while anorectal advancement flap had a 75 % failure rate. There was no recurrence seen in six cases after using the over-the-scope-clip (OTSC(®)) system to secure the internal opening.
  
  
  CONCLUSIONS
  VAAFT is useful in the identification of fistula tracts and enables closure of the internal opening. Adequate closure is essential with the method used to close large or fibrotic internal openings being the determining factor for success or failure. The OTSC system delivered the most consistent result without leaving a substantial perianal wound. Ensuring thorough curettage and drainage of the tract during VAAFT is also important to facilitate healing. We believe that this understanding will bring about a decrease in the high recurrence rates currently seen in many series of anal fistulae.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: I
authors.initials: I
authors.lastname: Seow-En
authors.affiliation: Fortis Colorectal Hospital, Singapore, Singapore. seowchoen@colorectalcentre.com.|, 290 Orchard Road, Paragon #06-06, Singapore, 238859, Singapore. seowchoen@colorectalcentre.com.
authors.forename: F
authors.initials: F
authors.lastname: Seow-Choen
authors.affiliation: Fortis Colorectal Hospital, Singapore, Singapore.
authors.forename: P K
authors.initials: PK
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D004322:Drainage / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*; D014945:Wound Healing; D055815:Young Adult
keywords: Anal fistula surgery; Anorectal advancement flap; Internal opening; OTSC; VAAFT