Friday 5 July 2019

Lupine Publishers-Open access journal of reproductive

The overall prevalence of anal fistula is 8-10 cases per 100,000 individuals with male female ratio of 2:1. Anal fistula may have a primary etiology, resulting from an anorectal abscess or can develop secondary to trauma, tuberculosis, Crohn's disease, anorectal carcinoma & exposure to radiation. Among the treatment options available for anal fistula, there are both traditional & novel techniques. Traditional methods include fistulotomy; fistulectomy& Seton placement are usually associated with incontinence. The newer treatment options include use of fibrin glue, bio-prosthetic plugs, mucosal advancement flaps & ligation of intersphincteric fistula tract (LIFT).These newer methods also have risk of incontinence as well as costly & need expertise. To overcome these difficulties Professor P. Meinero introduced a novel technique named Video Assisted Anal Fistula Treatment (VAAFT) in 2006 [1-5]. We adopted the technique with some modification in March 2015 in an effort to reduce postoperative morbidity & to enable our patients to benefit from advantages of minimal invasive surgery.

The purpose of the diagnostic phase is the correct identification of the fistula tract form the external to the inner opening and accessory tracts. The fistuloscope was then inserted through the external opening. Under continuous infusion of glycine solution, the fistuloscope was advanced through the fistula tract with direct visualization of the lumen [6-10]. The identification of incomplete secondary fistula tracts (meaning not associated with an external opening) is one of the major advantages of fistuloscopy when compared to conventional surgical exploration using a probe or methylene blue infusion. The purposes of the operative phase are destruction and cleaning ofthe fistula tract followed by management of the internal opening. For fistula tract destruction, the monopolar electrode was activated all the way under direct vision resulting in cauterization of the tract centimeter-by-centimeter form the level of the external orifice to the level of the internal opening. Jet irrigation and brush abrasion were used to remove necrotic material. The closure of the internal opening is another critical step to the cure of anal fistula. Its performance should be carefully conducted during surgery employing VAAFT. Here we used simple suture with vicryl 1/0 for closure of internal opening. We adopted certain modifications like no use of stapler and synthetic cyanoacrylate because of no availability and increasing cost of the procedure. Patients were anesthetized with spinal anaesthesia with lithotomy position. Preoperative single dose of 2nd generation cephalosporin was used and 1 dose of the same antibiotic was given post operatively. Postoperatively pain killer used were injectable opioids followed by oral pain killers for 3-5 days.

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