Background: To explore the efficacy of video-assisted anal fistula treatment (VAAFT) combined with an internal-opening closure technique using a stapler in the treatment of Parks II anal fistula.Methods: From September 2017 to June 2019, 75 patients with Parks II anal fistulas in Beijing Erlonglu Hospital were enrolled and randomly allocated into two groups. The 37 patients in the treatment group received VAAFT combined with internal-opening closure techniques, and the 38 patients in the control group were treated with anal fistulotomy with seton placement. The primary outcomes included the healing rate and recurrence, the fecal incontinence severity index (FISI) score, and the Wexner incontinence score during the 6-month postoperative follow-up.Results: Thirty-two cases were healed in the treatment group (86.5%) and thirty-six cases were cured in the control group (94.7%). There was no notable difference in the healing rate between the two groups (P=0.487). Significant differences between the groups were observed in the Wexner incontinence and FISI scores at 1, 3, and 6 months after the operation (P=0.001). Furthermore, the wound healing time in the treatment group was significantly shorter than in the control group (P<0.05), while the numerical rating scale (NRS) for postoperative pain on the first day and 1 week after the operation were significantly lower in the treatment group than in the control group (P<0.05).Conclusions: VAAFT combined with closure of the internal opening using a stapler is effective and safe for Parks II anal fistula, and should be promoted as a promising treatment.

Objective. The surgical treatment of complex anal fistulae is very challenging because of the incidence of incontinence after traditional approaches. There are no studies on the role of video-assisted anal fistula treatment (VAAFT) combined with anal fistula plug (AFP) in the complex anal fistulae. The aim of this study was to demonstrate the efficacy of treating complex anal fistulae using VAAFT combined with AFP. Method. This was a retrospective, nonrandomized observational study. 57 consecutive patients with complex anal fistulae who had undergone the VAAFT with AFP in our hospital between April 2016 and December 2019 were included. The primary outcomes were the cure rate, recurrence rate, and Wexner incontinence scores; the secondary outcomes were surgery time, blood loss, wound healing time postoperatively, pain, and patient satisfaction. Results. All 57 patients completed the surgery and follow-up, with an average follow-up time of 28 months; 6 patients suffered with recurrence (recurrence rate: 10.5%). The average surgery time was 57.9 minutes, and the average wound healing time was 46 days. There were no severe postoperative complications, and anal sphincter function was protected in all patients. Conclusions. The treatment of complex anal fistula by VAAFT combined with AFP is safe and effective, has a high healing rate and few postoperative complications, and is a promising surgery that can effectively protect the patient’s anal sphincter function.

Objective Horseshoe anal fistula is a common anorectal disease, and there is no standard procedure for its treatment. In this study, we performed a modified surgical procedure for the treatment of horseshoe anal fistula and investigated its efficacy and adverse effects. Methods We retrospectively analyzed the outcomes of video-assisted anal fistula treatment combined with an anal fistula plug (VAAFT-Plug) in 26 patients with a horseshoe anal fistula. The follow-up period ranged from 6 to 18 months. Preoperative and postoperative data were collected to analyze the cure rate, anal sphincter function, and incidence of complications. Results The surgeries were successfully performed in all patients, 23 of whom were cured (effective cure rate of 88.46%). Three patients developed recurrence and were cured after traditional surgery. No patients developed severe complications or postoperative anal incontinence. The VAAFT-Plug protocol was performed with a small incision in the fistula that subsequently promoted fistula healing and preserved sphincter function. Conclusion Although randomized controlled trials will be needed to fully validate these findings, our results suggest that VAAFT-Plug represents a promising treatment strategy for horseshoe anal fistulas. This technique preserves normal anal function and achieves satisfactory outcomes in most patients.

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