Video-assisted anal fistula surgery treatment (VAAFT)

  • Overview

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An anal fistula is a small tunnel that forms between the end of the bowel and the skin near the anus, where faeces exit the body. Typically, anal fistulas develop because of an infection near the anus that leads to the accumulation of pus (abscess) in the surrounding tissue. As the pus drains away, it can leave a small channel or tunnel behind. Anal fistulas can cause discomfort, skin irritation, unpleasant discharge, and usually do not heal spontaneously.

Surgery is often the recommended treatment for anal fistulas due to these symptoms. Video-Assisted Anal Fistula Treatment (VAAFT) involves using a miniature camera to examine the fistula tract. During the procedure, the surgeon uses a cautery to burn the internal lining of the tract and a brush to clean it. The internal opening of the fistula, leading to the anus or rectum, may be either closed during the procedure or left for closure at a later time.

The primary objectives of VAAFT are to locate the opening of the fistula, flush the fistula tract, and identify the trajectory of the fistula. Additionally, the procedure aims to reduce the necessity for MRI scans over time.

Another key goal of VAAFT is to close the fistula tract internally. This entails cleansing and cauterising the fistula canal, removing waste material, and closing the internal opening of the fistula. The reported success rate of VAAFT surgery ranges from 70% to 80-%.

Benefits of VAAFT in comparison to other treatments are:

  • It is performed under direct vision.
  • It helps to identify any possible secondary tracts or chronic abscesses.
  • It preserves anal continence.
  • Wounds are quite small and does not need packing of wound.
  • Pain experienced during the postoperative period is minimal.

What are adverse effects associated with VAAFT:

  • Following a VAAFT procedure, it is common for patients to experience minor bleeding and pain. Most individuals undergoing VAAFT may encounter some degree of bleeding from the wound or anus post-operation. This bleeding may be noticed after dressing changes, on stool, or on toilet paper while wiping. Such bleeding is typically benign and does not raise significant concerns. Wearing a small pad in your undergarments can help protect your clothing from staining.
  • Some patients may develop pus discharge from the external opening of the fistula. If this discharge is accompanied by a high temperature, it may indicate a wound infection. In such cases, antibiotics might be necessary to address the infection effectively.
  • Fluid is used to wash fistula tract during VAAFT and rarely this fluid escapes out of fistula tract and causes swelling. This swelling usually goes down over the course of 3-4 days and does not require any intervention.

    • Patients are encouraged to start moving around as soon as possible after the procedure. This helps improve your recovery and reduces the risk of certain complications. Within one to two hours of your operation, you will be encouraged to get up and walk around.

    Discharge from hospital will be the same day (for planned day-case surgery) or the following day.

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