VAAFT: Video-Assisted Anal Fistula Treatment - Dr. Piercarlo Meinero

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The Technique The hermetic closure of the internal fistula opening can also be accomplished by using a linear stapler (Fig. 26–28). This also depends on the internal opening position. Fig. 25 26 Fig. Fig. 26 27 Fig. 28 Using a semicircular stapler, the suture will be horizontal. Using a linear stapler, the suture will be vertical (Fig. 29–31) Fig. 28 Fig. 29 Fig. 29 Fig. 30 Fig. 31
When the tissue in the area of the internal opening is not sclerotic and allows to form a good "volcano", the stapler can be used, however if the tissue around the internal opening is too rigid and sclerotic, the use of the stapler might be difficult. In this case a cutaneous mucosal flap would be preferred Fig. 32). As a last step we insert 0,5 ml of synthetic cyanoacrylate right after the suture / staple line via the fistula pathway to further reinforce the suture. Fig. 32 So the use of the synthetic cyanoacrylate behind the suture line or behind the flap assures the perfect opening closure. It is essential to keep in mind that not the whole fistula tract is filled up with the synthetic cyanoacrylate; only a small amount is inserted directly below the suture line. That's why the fistula pathway has to stay open to allow the passage of secretions. (Fig. 33–36). Fig. 33 Fig. 34 Fig. 35 Fig. 36 This procedure assures a perfect excision and a hermetic closure of the internal fistula opening, excluding the risk of stool passage. Since the suture is situated tangential to the sphincter, the postoperative pain is low even if the suture falls both in the anal canal and the rectum. 10 11 10 11
Page 1 and 2: VAAFT: Video-Assisted Anal Fistula
Page 3 and 4: Materials KARL STORZ Equipment is u
Page 5 and 6: The surgeon follows the fistula pat
Page 7 and 8: 2. The operative phase purpose of t
Page 9: At this point we completely remove
Page 13 and 14: Instrument Set VAAFT Instrument Set
Page 15 and 16: Cold Light Fountain XENON 300 SCB
Page 17 and 18: IMAGE 1 HD HD Camera Head 22 2200 5
Page 19 and 20: Features and Benefits � Digital s
Page 21 and 22: Notes 20 21
Page 23 and 24: Notes 22 23

VAAFT: Video-Assisted Anal Fistula Treatment - Dr. Piercarlo Meinero

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