Effectiveness of Video-assisted Anal Fistula Treatment (VAAFT) and Its Adjuncts in the Treatment of a Cohort of Patients with Recurrent Fistula-in-ano

Abstract

Recurrence of disease after surgery for fistula occurs in approximately 30%–40% of patients. Treatment of a recurrent fistula has an increased risk of failure and further recurrence. The aim of this study was to find out the effectiveness of video-assisted anal fistula treatment (VAAFT) in the treatment of recurrent fistula and also to compare the effect of the two adjuvants, fibrin and platelet-rich fibrin (PRF), in reducing recurrence in a recurrent fistula. A retrospective observational study was done on a cohort of patients with fistula-in-ano being treated at our center between 2015 and 2021. Of 85 patients that underwent VAAFT, 36 had recurrent disease and were allotted to two groups, one group receiving fibrin and the other PRF. Details of patients were collected from the hospital database and by telephonic interview. To test the statistical significance of the difference in the proportion of categorical variables between two groups, chi-square test was used and Mann–Whitney U test for the difference in the mean-time of healing between two groups. Recurrence rate following VAAFT in patients with recurrent fistula-in-ano in our series was found to be 25%. A significant reduction in recurrence was noted in patients who received PRF as adjunct when compared to patients who received fibrin glue as adjunct (P = 0.0023). VAAFT is an excellent cost-effective choice for the management of recurrent fistula-in-ano. Use of PRF along with VAAFT improves the outcome of the procedure.