Technique and Preliminary Outcomes of Video-Assisted Ligatio
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Sphincter-preserving operations have been increasingly used for treating anal fistula. However, their success rates remain modest in complex anal fistulas.

This study aimed to report outcomes of video-assisted ligation of intersphincteric fistula tract for treating complex anal fistulas and to compare its results with conventional ligation of intersphincteric fistula tract. It was conducted at a large tertiary hospital in Thailand. A review of prospectively collected data from October 2014 to December 2017 was performed.

All patients with primary or recurrent complex anal fistulas undergoing video-assisted ligation of intersphincteric fistula tract were included. Patients with anal fistula related to malignancy, Crohn’s disease, tuberculosis, or acute abscess were excluded.

Healing as defined by an absence of fistula or drainage from an external opening and complete epithelialization of the external opening were measured.

Results:
This study included 103 patients with a median age of 47 years. The primary healing rate was 84.5% at a median follow-up of 28 months. Primary healing rates of anterior high transsphincteric fistula, semi-horseshoe fistula, and horseshoe fistula were 88%, 77%, and 93%. Median time to healing was 4 weeks.

Accordingly, the overall failure rate was 15.5%. None reported worse fecal incontinence postoperatively. Video-assisted ligation of intersphincteric fistula tract had a higher rate of primary healing for complex anal fistula than ligation of intersphincteric fistula tract.

Conclusions:
They concluded that the outcomes of video-assisted ligation of intersphincteric fistula tract for complex anal fistulas are quite good. This technique has the potential to become another viable option of sphincter-preserving operation for complex anal fistulas.

Source: https://journals.lww.com/dcrjournal/Abstract/2020/11000/Video_Assisted_Ligation_of_Intersphincteric.8.aspx
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