Aim: Complex anal fistula represents a burden for patients, and its management is a challenge for surgeons. Video-assisted anal fistula treatment (VAAFT) is one sphincter-sparing technique. However, data on its long-term effectiveness are scant. We aimed to explore the outcomes of VAAFT in a retrospective cohort of patients referred to a tertiary centre.Method: Consecutive adult patients with a minimum of 2 years' follow-up after VAAFT were reviewed. Patients were followed up to 5 years postoperatively. Failure was defined as incomplete healing of the external orifice(s) during the first 6 months. Recurrence was defined as new radiologically and/or clinically confirmed onset of the fistula after primary healing. A generalized linear model was fitted to evaluate the association between failure and sociodemographic characteristics. Predictors of recurrence were determined in a subgroup analysis of patients found to be free from disease at 6 months postoperatively.Results: Overall, 106 patients (70% male; mean age 41 years) were reviewed. Of these 86% had a previous seton placement. Fistulas were either high trans-sphincteric (74%), suprasphincteric (12%) or extrasphincteric (13%). Eight (7%) patients experienced postoperative complications, none of which required reintervention. Mean follow-up was 53 +/- 13.2 months. VAAFT failed in 14 (13%) patients. The overall recurrence rate ranged from 29% at 1 year to 63% at 5 years. Multiple external orifices, suprasphincteric fistula, younger age, previous surgery and higher complexity of the fistulous tract were independent risk factors for recurrence.Conclusion: VAAFT is a safe sphincter-sparing technique. The initially high success rate decreases over time and relates to a higher degree of complexity.

Long term results of video‐assisted anal fistula treatment for complex anal fistula: another shattered dream? / La Torre, M; Goglia, M; Micarelli, A; Fiori, E; D'Andrea, V; Grossi, U; Tierno, Sm; Tomassini, F; Gallo, G. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 25:10(2023), pp. 2017-2023. [10.1111/codi.16732]

Long term results of video‐assisted anal fistula treatment for complex anal fistula: another shattered dream?

Goglia M;Fiori E;D'Andrea V;Gallo G
Ultimo
2023

Abstract

Aim: Complex anal fistula represents a burden for patients, and its management is a challenge for surgeons. Video-assisted anal fistula treatment (VAAFT) is one sphincter-sparing technique. However, data on its long-term effectiveness are scant. We aimed to explore the outcomes of VAAFT in a retrospective cohort of patients referred to a tertiary centre.Method: Consecutive adult patients with a minimum of 2 years' follow-up after VAAFT were reviewed. Patients were followed up to 5 years postoperatively. Failure was defined as incomplete healing of the external orifice(s) during the first 6 months. Recurrence was defined as new radiologically and/or clinically confirmed onset of the fistula after primary healing. A generalized linear model was fitted to evaluate the association between failure and sociodemographic characteristics. Predictors of recurrence were determined in a subgroup analysis of patients found to be free from disease at 6 months postoperatively.Results: Overall, 106 patients (70% male; mean age 41 years) were reviewed. Of these 86% had a previous seton placement. Fistulas were either high trans-sphincteric (74%), suprasphincteric (12%) or extrasphincteric (13%). Eight (7%) patients experienced postoperative complications, none of which required reintervention. Mean follow-up was 53 +/- 13.2 months. VAAFT failed in 14 (13%) patients. The overall recurrence rate ranged from 29% at 1 year to 63% at 5 years. Multiple external orifices, suprasphincteric fistula, younger age, previous surgery and higher complexity of the fistulous tract were independent risk factors for recurrence.Conclusion: VAAFT is a safe sphincter-sparing technique. The initially high success rate decreases over time and relates to a higher degree of complexity.
2023
vaaft; anal fistula; sphincter-sparing; video-assisted
01 Pubblicazione su rivista::01a Articolo in rivista
Long term results of video‐assisted anal fistula treatment for complex anal fistula: another shattered dream? / La Torre, M; Goglia, M; Micarelli, A; Fiori, E; D'Andrea, V; Grossi, U; Tierno, Sm; Tomassini, F; Gallo, G. - In: COLORECTAL DISEASE. - ISSN 1462-8910. - 25:10(2023), pp. 2017-2023. [10.1111/codi.16732]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1714081
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