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Video-Assisted Anal Fistula Treatment (VAAFT) for complex anorectal fistula: efficacy and risk factors for failure at 3-year follow-up

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Abstract

Background

The aim of this study was to assess the 3-year objective and subjective outcomes of patients with complex anorectal fistula treated with Video-Assisted Anal Fistula Treatment (VAAFT). Furthermore, we evaluated the risk factors associated with recurrence.

Methods

All consecutive patients with complex anorectal fistula who underwent VAAFT in Beata Vergine Hospital of Mendrisio, Switzerland, from January 2013 to January 2016, were enrolled. Patients with suspicion or diagnosis of Crohn’s disease, malignancy, previous history of radiotherapy or radical pelvic surgery were excluded. Preoperative clinical assessment based upon medical history, physical examination and endosonography, was performed in all patients. Data regarding subjective outcomes (the Patient Global Impression of Improvement, patient satisfaction scores and Wexner score), objective cure rate (absence of fistula at clinical examination), and adverse events were collected during follow-up. Uni and multivariate analysis were performed to investigate outcomes.

Results

One hundred and four patients had VAAFT. At 3-year follow-up, 96 patients (92.3%) were available for the evaluation. At 3 years after surgery, 81 of 96 patients (84.4%) declared themselves cured (p = 0.60). Similarly, at 3-year evaluation, 80 of 96 patients (83.3%) were objectively cured (p = 0.52). No serious intraoperative or postoperative complications were reported. All recurrences were treated with a repeat VAAFT procedure resulting in a complete healing. Uni and multivariate analysis of variables potentially involved in the failure of VAAFT showed that age ≥ 50 years was the only factor associated at risk of recurrence.

Conclusions

VAAFT is a highly effective safe procedure for the treatment of anorectal fistula, with a low recurrence rate at 3-year follow-up. However, our study demonstrated that age ≥ 50 years is a risk factor for failure of VAAFT.

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Authors and Affiliations

  1. Department of General Surgery, EOC-Beata Vergine Hospital, Mendrisio, Switzerland

    L. Regusci, F. Fasolini & P. Meinero

  2. Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Via Turconi 23 CP 1652, 6850, Mendrisio, Switzerland

    G. Caccia, G. Ruggeri & A. Braga

  3. Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy

    M. Serati

Authors
  1. L. Regusci
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  2. F. Fasolini
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  3. P. Meinero
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  4. G. Caccia
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  5. G. Ruggeri
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  6. M. Serati
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  7. A. Braga
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Corresponding author

Correspondence to A. Braga.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted according to the tenets of the Declaration of Helsinki. No Institutional Review Board approval was required for this study because there was no deviation from normal clinical practice.

Informed consent

Preoperative written informed consent for VAAFT procedure was obtained from all patients.

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Regusci, L., Fasolini, F., Meinero, P. et al. Video-Assisted Anal Fistula Treatment (VAAFT) for complex anorectal fistula: efficacy and risk factors for failure at 3-year follow-up. Tech Coloproctol 24, 741–746 (2020). https://doi.org/10.1007/s10151-020-02213-w

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