Anal fistula

Dr. Valentina Giaccaglia is proud to offer the latest minimally invasive technique from Italy to treat anal fistula called 

VAAFTVideo Assisted Anal Fistula Treatment

This method is the only one that allows to treat anal fistula without pain, with very low recurrence rate and absolutely no incontinence risk.

After careful evaluation with a proctological visit completed with anoscopy and, if necessary, endorectal 3D ultrasound, the anal fistula can be classified in simple or complex, depending on anal sphincters involvement (muscles involved in the continence mechanism).

If the fistula is simple, and this means located in the lower part of the anal canal and/or involving only a small part of  the muscles, then simple fistulotomy is performed. It consists in direct opening and curettage of the fistula tract that will heal within the next 15-20 days.

If the fistula is complex, therefore situated high in the anal canal and/or involving a considerable part of the sphincters, a more complex surgical approach needs to be used, paying the utmost attention in order not to damage the muscles involved in the continence mechanism.

Traditional techniques, such as the ‘seton’ are extremely painful and cause a lot of discomfort to the patients because of the constant anal discharge together with the needing of 3 times a week painful medications.

For that reason, new techniques have been developed in order to reduce post-operative pain and decrease sphincters damage. Between them, Video Assisted Anal Fistula Treatment (VAAFT) is gaining wide acceptance in the surgical community because of the high healing rate and the near to zero incontinence. This new surgical technique is performed with a special fistuloscope that allows to perform both a diagnostic and a curative phase.

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In fact, the fistuloscope, enters directly in the fistula tract, showing on the video all the tracks, that are quite often multiple and not recognized.

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After the initial diagnostic phase and the individuation of the internal opening, the surgical part is performed with cauterization of the tract/s and closure of the internal opening.

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We use for the internal opening closure, an advancement rectal flap that is a piece of mucosa and submucosa taken from the rectum (with an intact vascular pedicle) and transposed over the internal orifice in order to definitively close it.

This procedure is performed in a Day Surgery setting, and the patient can go home and have shower the same day. He/she just needs to wash the external opening with saline solution twice a day.

Healing is normally registered between 7 and 21 days, depending on the complexity of the fistula, with no need of painful dressings or special visits. The patient is normally able to resume daily activities in 2-3 days.