Symptom Amelioration in Crohn's Perianal Fistulas Using Video-Assisted Anal Fistula Treatment (VAAFT)
| Autor: | Phillip Lung, Ailsa Hart, R. K. S. Phillips, Samuel O Adegbola, R. Strouhal, Philip J. Tozer, Omar Faiz, Janindra Warusavitarne, Kapil Sahnan |
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| Rok vydání: | 2018 |
| Předmět: |
Anal fistula
Adult Male medicine.medical_specialty Adolescent medicine.medical_treatment Fistula Video-Assisted Surgery Disease 03 medical and health sciences Young Adult 0302 clinical medicine Postoperative Complications Quality of life Crohn Disease medicine Clinical endpoint Humans Rectal Fistula Patient Reported Outcome Measures Crohn's disease Fulguration business.industry Gastroenterology General Medicine Middle Aged medicine.disease Surgery Treatment Outcome 030220 oncology & carcinogenesis Cauterization Quality of Life Feasibility Studies 030211 gastroenterology & hepatology Female business |
| Zdroj: | Journal of Crohn'scolitis. 12(9) |
| ISSN: | 1876-4479 |
| Popis: | Background and aims A third of patients with Crohn's disease develop perianal fistulas. These are associated with a significant burden of symptoms and negative impact on quality of life. This study reports the use of video-assisted anal fistula treatment [VAAFT] as a means of symptom improvement; this is a minimally invasive technique to access fistula track, and diagnose/facilitate drainage of deep/complex secondary extensions with cauterization of excess inflammatory tissue. Methods Consecutive patients with complex Crohn's fistula undergoing VAAFT for symptomatic Crohn's anal fistula were included. They were identified from a prospectively maintained database, which was interrogated from June 2015 to November 2017. Patients underwent diagnostic fistuloscopy and fulguration of tracts/secondary extensions. Setons were sited/replaced after the procedure to maintain postoperative drainage. The primary endpoint was completion of the 'Measure your medical outcome profile' [MYMOP2] quality of life [QoL] questionnaire at 6 weeks postoperatively. Secondary outcome measures were a decisional regret scale [DRS], postoperative complications and the 30-day re-operation rate. Results Twenty-five patients underwent the procedure during the study period. In total, 21/25 patients [84%] provided MYMOP2 QoL data demonstrating a statistically significant improvement in both pain and discharge scores. Eighty-one per cent of patients who completed the questionnaire agreed/strongly agreed that the procedure was the right decision and no patient regretted undergoing the procedure. There was one re-operation but otherwise no complications. Conclusions This study demonstrates the feasibility, safety and importantly an improvement in patient-reported outcomes in a series of patients undergoing VAAFT for complex Crohn's anal fistula. VAAFT reduces the main symptoms [pain and discharge] in patients with complex refractory anal fistulas. |
| Databáze: | OpenAIRE |
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