Video-assisted anal fistula treatment: technical considerations and preliminary results of the first brazilian experience

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

Carlos Ramon Silveira Mendes¹  Luciano Santana De Miranda Ferreira¹  Ricardo Aguiar Sapucaia¹  Meyline Andrade Lima¹  Sergio Eduardo Alonso Araujo¹ 

关键词: Rectal fistula;    Surgical procedures;    Minimally invasive;    Fecal incontinence;    Crohn's disease;    Fístula retal;    Procedimentos cirúrgicos minimamente invasivos;    Incontinência fecal;    Doença de Crohn;   

DOI  :  10.1590/S0102-67202014000100018

来源: SciELO

【 摘 要 】

Backgroung : Anorectal fistula represents an epithelized communication path of infectious origin between the rectum or anal canal and the perianal region. The association of endoscopic surgery with the minimally invasive approach led to the development of the video-assisted anal fistula treatment.Aim : To describe the technique and initial experience with the technique video-assisted for anal fistula treatment.Technique : A Karl Storz video equipment was used. Main steps included the visualization of the fistula tract using the fistuloscope, the correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening which can be accomplished through firing a stapler, cutaneous-mucosal flap, or direct closure using suture.Results : The mean distance between the anal verge and the external anal orifice was 5.5 cm. Mean operative time was 31.75 min. In all cases, the internal fistula opening could be identified after complete fistuloscopy. In all cases, internal fistula opening was closed using full-thickness suture. There were no intraoperative or postoperative complications. After a 5-month follow-up, recurrence was observed in one (12.5%) patient.Conclusion : Video-assisted anal fistula treatment is feasible, reproducible, and safe. It enables direct visualization of the fistula tract, internal opening and secondary paths.

【 授权许可】

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