Search

Video-Assisted Anal Fistula Treatment (VAAFT) is a novel minimally invasivesphincter-saving technique for treating complex fistula-in-ano involving endoscopic assessmenttreatment of perianal fistula. This retrospective, non-randomized, observational study is the first Australian study of VAAFT. It is also the longest study of VAAFT to-date.From January 2014 to September 2019, 59 patients with a complex anal fistula were identified via MRIunderwent VAAFT. Fourteen patients had undergone previous definitive surgery for anal fistula. Specialized Karl Storz video equipment (fistuloscope) was used in the procedure. The rigid fistuloscope was used to directly visualize the fistula tract/sinternal opening. Closure of the internal opening was then performed. The fistula tract/s were then treated via fulguration. The external opening was kept patentdressed. Patients were then followed up for a mean 59.5 months.67.9% (n = 38) of patients achieved primary healing (needing nil further intervention) at a median of 13 weeks. 12.5% (n = 7) experienced healing followed by recurrence while 19.6% (n = 11) experienced non-healing. Of the recurrence/non-healing groups, 11/18 underwent repeat VAAFT with healing occurring in 10/11 patients at a median of 7 weeks. The mean operating time was 41.1 min. There were no major complicationscontinence scores were not affected. Three patients were lost to follow up.VAAFT is both effectivesafe for the treatment of complex fistula-in-ano. Its minimally invasive nature means that in the instance of recurrence or persistence, VAAFT can be repeated with minimal morbidityreasonable likelihood of success.

Sigmoid-urachal fistula is exceedingly rare in adults and only a few cases have been reported in the world literature. We present the case of a 54-year-old man with symptomatic sigmoid-urachal fistula managed successfully with a laparoscopic assisted high anterior resection, primary anastomosis and an en bloc resection of the urachal cyst and the involved cuff of bladder.