Long-term outcomes of video-assisted anal fistula treatment

Anal fistula is a common and challenging condition to manage, requiring a balance between achieving healing and preserving continence. Video-assisted anal fistula treatment (VAAFT) is a minimally invasive, endoscopic approach that allows direct visualisation and debridement of the fistula tract. Although short-term outcomes are promising, evidence regarding its long-term durability remains limited. This study provides one of the longest follow-up assessments of VAAFT outcomes to date.

This observational study utilises a prospectively maintained database of patients who underwent VAAFT between November 2014 and June 2016 at a single UK centre. All patients with a minimum of five years of follow-up were included. Data collected included sex, age, fistula type (simple vs. complex), comorbidities (inflammatory bowel disease and diabetes mellitus), smoking status, previous fistula surgery, and subsequent fistula-related procedures (if any). The primary outcome was healing, defined as the absence of fistula-related symptoms at review. Secondary outcomes were postoperative continence deterioration and complications.

A total of 74 patients underwent VAAFT during the study period, and 48 patients (mean age 48 years, SD 13, 58.3% male) completed a minimum of 5 years' follow-up (median 79 months, IQR 67-82). The majority (77%) were complex-type fistula (versus simple). At their most recent follow-up appointment, 66.7% achieved healing and a further 27% reported partial symptomatic improvement. Only one reported worsened continence (loss of flatus control), and there was one self-resolving haematoma. Follow-up duration was comparable between healed and symptomatic groups. No significant association was found between healing and sex, age, fistula type, or surgical history.

VAAFT provides durable symptom relief for many patients and carries a low risk of complications or continence impairment. However, long-term complete healing rates appear modest, underscoring the importance of appropriate patient selection and counselling. Further prospective studies are warranted to refine indications and optimise long-term outcomes.