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Minerva Chirurgica 2018 April;73(2):142-50

DOI: 10.23736/S0026-4733.18.07390-X


lingua: Inglese

Video-assisted anal fistula treatment in the management of complex anal fistula: a single-center experience

Alessandro STAZI 1, Paolo IZZO 2, Francesco D’ANGELO 3, Monica RADICCHI 1, Manuele MAZZI 1, Federico TOMASSINI 3, Luciano IZZO 2, Stefano VALABREGA 2

1 Department of General Surgery, Colorectal Pelvic Center, Madonna delle Grazie Clinic, Velletri, Rome, Italy; 2 Pietro Valdoni Department of Surgery, Sapienza University, Rome, Italy; 3 Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University, Rome, Italy


BACKGROUND: Video-assisted anal fistula treatment (VAAFT) is now a mature technique, supported by many short-term published case series.
METHODS: We designed a monocentric, retrospective and observational study in order to evaluate early and long-term outcomes of VAAFT in the treatment of primary and recurrent complex anal fistula. Between November 2011 and March 2014, 224 consecutive patients affected by complex perianal fistula underwent Video Assisted Anal Fistula Treatment. Fifty-two were affected by primary and 172 by recurrent disease. We registered all intra and postoperative complications and healing rate. Median follow-up was 48 months (range 27-60 months).
RESULTS: In the primary fistula group, 40 of the 52 patients were completely healed within 3 months after surgery (77%); at 12 months, considering also 12 patients (23%) treated with a second VAAFT due to recurrent disease, the overall healing rate was 92.3% In the second group with recurrent anal fistula (N.=172), primary healing was observed in 110 patients (64%; P=0.1) within 3 months after surgery and increases to 80.2%, after 12 months (P=0.06). Few patients required analgesics in the postoperative period (N.=33, 14.7%), the remaining did not require pain killers at all. All patients were able to resume daily activities within 7 days from surgery (range 2-12 days). Main limitation of our study was its retrospective and monocentric design.
CONCLUSIONS: VAAFT seems to be a safe and effective technique for treating primary and recurrent perianal fistula, providing a very good healing rate without sphincters impairment and allowing a very quick return to normal activities.

KEY WORDS: Video-assisted surgery - Rectal fistula - Digestive system surgical procedures

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