Complex anal fistula is challenging to treat because the priorities — eradicating the tract and preserving continence — can conflict. Video-assisted anal fistula treatment (VAAFT) is a sphincter-preserving, minimally invasive technique that uses endoscopic visualization to treat the fistula from within the tract itself.
Equipment
The core instrument is a fine fistuloscope that provides illumination and magnified visualization inside the tract, coupled with irrigation to distend and clean the tract. Accessory instruments allow ablation of the tract lining and clearance of granulation tissue, and the internal opening is closed with sutures or a stapler.
Technique
The procedure has a diagnostic and an operative phase. In the diagnostic phase, the fistuloscope is advanced along the tract under irrigation to precisely locate the internal opening — a decisive step, since a missed internal opening is a common cause of recurrence. In the operative phase, the tract is ablated under direct vision, debris is cleared, and the internal opening is securely closed.
Patient selection
VAAFT is particularly suited to complex, high, or recurrent fistulas where cutting the sphincter would risk continence. Direct visualization is valuable when the anatomy is uncertain or there are secondary tracts. As with all fistula surgery, active sepsis is drained first, often with a preliminary seton.
Advantages and outcomes
The principal advantages are sphincter preservation and accurate identification of the internal opening under vision. Reported outcomes show acceptable healing with a low risk of incontinence, and the ability to repeat or combine the technique with other sphincter-sparing procedures. Careful case selection and complete closure of the internal opening drive success.
INVAMED technologies in this space
INVAMED develops proctology and fistula-management devices; explore the hemorrhoid and fistula management category.
Device availability and approved indications vary by country. This content is prepared for healthcare professionals and does not replace clinical judgment or the instructions for use.