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Techniques in Coloproctology

, Volume 21, Issue 10, pp 775–782 | Cite as

Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review

  • S. O. AdegbolaEmail author
  • K. Sahnan
  • G. Pellino
  • P. J. Tozer
  • A. Hart
  • R. K. S. Phillips
  • J. Warusavitarne
  • O. D. Faiz
Review

Abstract

Background

The surgical treatment of complex anal fistulae, particularly those involving a significant portion of the anal sphincter in which fistulotomy would compromise continence, is challenging. Video-assisted anal fistula treatment (VAAFT), fistula tract laser closure (FiLaC™) and over-the-scope clip (OTSC®) proctology system are all novel sphincter-sparing techniques targeted at healing anal fistulae. In this study, all published articles on these techniques were reviewed to determine efficacy, feasibility and safety.

Methods

A systematic search of major databases was performed using defined terms. All studies reporting on experience of these techniques were included and outcomes (fistula healing and safety) evaluated.

Results

Eighteen studies (VAAFT—12, FiLaC™—3, OTSC®—3) including 1245 patients were analysed. All were case series, and outcomes were heterogeneous with follow-up ranging from 6 to 69 months and short-term (< 1 year) healing rates of 64–100%. Morbidity was low with only minor complications reported. There was one report of minor incontinence following the first reported study of FiLaC™, and this was treated successfully at 6 months with rubber band ligation of hypertrophied prolapsed mucosa. There are inconsistencies in the technique in studies of VAAFT and FiLaC™.

Conclusions

All three techniques appear to be safe and feasible options in the management of anal fistulae, and short-term healing rates are acceptable with no sustained effect on continence. There is, however, a paucity of robust data with long-term outcomes. These techniques are thus welcome additions; however, their long-term place in the colorectal surgeon’s armamentarium, whether diagnostic or therapeutic, remains uncertain.

Keywords

Anal fistula VAAFT Video-assisted anal fistula treatment Over-the-scope clip Fistula tract laser closure 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present paper as a review of the literature was exempt from approval.

Informed consent

For this review of the literature, informed consent was not required.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • S. O. Adegbola
    • 1
    • 2
    Email author
  • K. Sahnan
    • 1
    • 2
  • G. Pellino
    • 1
  • P. J. Tozer
    • 1
    • 2
  • A. Hart
    • 1
    • 2
  • R. K. S. Phillips
    • 1
    • 2
  • J. Warusavitarne
    • 1
    • 2
  • O. D. Faiz
    • 1
    • 2
  1. 1.Fistula Research UnitSt Mark’s Hospital and Academic InstituteHarrowUK
  2. 2.Department of Surgery and Cancer, Faculty of MedicineImperial College LondonLondonUK

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