Abstract 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 VAAFT as a means of symptom improvement; with minimally invasive technique to access fistula track, diagnose/facilitate drainage of deep/complex secondary extensions with cauterization of excess inflammatory tissue. Methods Consecutive patients with complex Crohn’s fistula undergoing a VAAFT for symptomatic Crohn’s anal fistula were included. They were identified from a prospectively maintained database, which was interrogated from June 2015-November 2017. Patients underwent diagnostic fistuloscopy and fulguration of tracts/secondary extensions. Setons were sited/replaced after the procedure to maintain postoperative drainage. 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), post-operative complications and the thirty-day re-operation rate. Results 25 patients underwent the procedure during the study period. 21/25 patients (84%) completed MYMOP2 QoL data demonstrating a statistically significant improvement in both pain and discharge scores. 81% of patients who completed the agreed/strongly agreed that the procedure was right decision and no patient regretted undergoing the procedure. There was 1 reoperation but otherwise no complications. Conclusions This study demonstrates 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. Vaaft, fistula, patient reported outcomes © European Crohn’s and Colitis Organisation (ECCO) 2018. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact email@example.com
Journal of Crohn's and Colitis – Oxford University Press
Published: May 25, 2018
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