Video-Assisted Anal Fistula Treatment (VAAFT) for Complex Perianal Fistulae with Long-Term Follow-Up

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OBJECTIVE: To evaluate the clinical outcomes of video-assisted anal fistula treatment (VAAFT) in patients with complex perianal fistulae, with particular focus on complications and recovery. STUDY DESIGN: A non-randomised observational study. Place and Duration of the Study: Department of Surgery, Shifa International Hospital, Islamabad, Pakistan, from January 2013 to September 2023. METHODOLOGY: All cases of complex perianal fistula undergoing VAAFT were included in the study. Patients were followed up postoperatively in the surgical clinic for persistent discharge, wound healing, and recurrence at six weeks, six months, and annually. Frequency and percentages were calculated for categorical data, and the Chi-square test was applied to determine significance. RESULTS: Total number of cases enrolled was 171. The mean age was 41.73 ± 12.05 years; the male-to-female ratio was 12:1. Ninety-one (53.2%) cases were operated for recurrent disease. Twenty cases (11.7%) were complex trans-sphincteric grade 4, thirty (17.5%) were extra-sphincteric grade 4, seventeen (9.9%) were inter-sphincteric grade 2, sixty-two (36.3%) were trans-sphincteric grade 2, and twenty-three (13.5%) were trans-sphincteric grade 3. Twenty (11.6%) had persistent discharge at six months, and thirty-one (17.9%) had recurrence at two years. CONCLUSION: VAAFT has very good results regarding recurrence. KEY WORDS: Perianal fistula, Recurrence, Video-assisted anal fistula treatment, Abscess, Trans-sphincteric fistula.

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