Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press48110.17650/2686-9594-2020-10-3-4-27-33ORIGINAL REPORTОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕMinimally invasive video-assisted sphincter-sparing treatment of complex rectal fistulas using the VAAFT techniqueТактика малоинвазивного видеоассистированного сфинктеросберегающего лечения сложных свищей прямой кишки по методике VAAFTAtroschenkoA. O.АтрощенкоА. О.
Russian Federation

45 Losinoostrovskaya St., 107150 Moscow

107150 Москва, ул. Лосиноостровская, 45

dr.atroshchenko@gmail.comPozdnyakovS. V.ПоздняковС. В.
Russian Federation

45 Losinoostrovskaya St., 107150 Moscow

107150 Москва, ул. Лосиноостровская, 45

TeterinA. V.ТетеринА. В.
Russian Federation

45 Losinoostrovskaya St., 107150 Moscow

107150 Москва, ул. Лосиноостровская, 45

Clinical Hospital of the Presidential Administration of Russian FederationФГБУ «Клиническая больница» Управления делами Президента Российской Федерации30122020103-427333012202030122020Copyright ©; 2020, Atroschenko A.O., Pozdnyakov S.V., Teterin A.V.Copyright ©; 2020, Атрощенко А.О., Поздняков С.В., Тетерин А.В.2020Atroschenko A.O., Pozdnyakov S.V., Teterin A.V.Атрощенко А.О., Поздняков С.В., Тетерин А.В.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/481

Background. Video-assisted anal fistula treatment (VAAFT) is a new minimally invasive sphincter-sparing technology.

Objective: to describe technical characteristics of VAAFT and evaluate short-term outcomes.

Materials and methods. We used a specialized surgical video system (VAAFT®; Karl Storz) for the treatment of complex high rectal fistulas. This technology allows a surgeon to use a special fistuloscope to perform visual examination of the fistula, find its internal opening, and detect secondary fistula passages and inflows. In addition to visual inspection, it is possible to simultaneously conduct a cytological brush through the working channel of the endoscope in order to clear the fistula from detritus and desquamate lining mucosa, and then perform fistula ablation using a monopolar electrode. The internal opening of the fistula can be either closed by a flap or sutured using a linear stapling device or closed using an endoscopic clip with additional sealing of the suture line with biological glue.

Results. Between September 2017 and August 2019, a total of 112 patients underwent VAAFT® surgeries. Ninety-three patients (83 %) were followed up for 6 months postoperatively. We observed no significant complications during the follow-up period. The majority of study participants (85 %) did not experience severe pain (>2–4 points on a visual-analog scale) in the early postoperative period. Primary healing was achieved in 98 patients (87.5 %) within 2–3 months. Eighty-nine individuals (79.5 %) were followed up for more than 1 year. Rectal fistula healing within 1 year after VAAFT® surgery was observed in 82 % of patients.

Conclusions. The main advantage of the VAAFT® technique is the combination of the diagnostic stage for fistula visualization and identification of the internal opening with the possibility of simultaneous surgical treatment.

Введение. Видеоассистированная методика лечения свищей прямой кишки (video-assisted anal fistula treatment, VAAFT) – новая малоинвазивная сфинктеросохраняющая технология.

Цель исследования – описание технических особенностей выполнения видеоассистированной методики лечения свищей прямой кишки и оценка непосредственных результатов.

Материалы и методы. Для лечения сложных высоких свищей прямой кишки применена специализированная хирургическая видеосистема фирмы Karl Storz – VAAFT®. Данная технология позволяет с помощью специального фистулоскопа выполнять визуальный осмотр свищевого хода, находить внутреннее отверстие свища прямой кишки, выявлять наличие вторичных свищевых ходов и затеков. Кроме визуального осмотра возможно одномоментное проведение через рабочий канал эндоскопа цитологической щеточки с целью санации просвета свищевого хода от детрита и десквамации слизистой выстилки, а затем выполнение аблации свищевого хода при помощи монополярного электрода. Внутреннее отверстие свищевого хода ликвидируется по методике перемещенного лоскута или прошивается линейным степлерным аппаратом, либо закрывается эндоскопической скрепкой с дополнительной герметизацией линии шва биологическим клеем.

Результаты. В период с сентября 2017 г. по август 2019 г. прооперировано 112 пациентов по методике VAAFT®. Прослежены в течение 6 мес после операции 93 (83 %) пациента. Значимых осложнений за время наблюдения выявлено не было. Болевой синдром в раннем послеоперационном периоде в 85 % случаев не превышал 2–4 баллов по визуально-аналоговой шкале. Первичное заживление достигнуто у 98 (87,5 %) пациентов в течение 2–3 мес. Прослежены более 1 года после операции 89 (79,5 %) пациентов. Заживление свища прямой кишки в течение 1-го года после лечения по методике VAAFT® отмечено у 82 % пациентов.

Выводы. Основным преимуществом методики VAAFT® является сочетание диагностического этапа по визуализации свищевого хода и идентификации внутреннего отверстия с возможностью одномоментного хирургического лечения.

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