Other techniques

Other techniques

Video-assisted anal fistula treatment (V AAFT) involves the introduction of a rigid fistuloscope into the tract through the external opening. The scope has a channel to accommodate a forceps, brush or diathermy . The scope is passed into accessible tracks to allow lavage, curettage, cautery or the introduction of setons. V AAFT represents a form of advanced track identifica - tion and preparation before a definitive technique is performed. Fistula tract laser closure (FiLaC) uses radial emitting laser to - obliterate the luminal aspect of the fistula to a known depth, throughout its length. An over-the-scope clip (OTSC) involves closing the internal opening using a nitinol clip, disconnecting the external tract. Clip migration and elective removal because of pain are the main complications. The FISCLOSE trial is currently recruiting. Summary box 80.12 Anorectal fistulae /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

(c) Figure 80.38 Ligation of an intersphincteric /f_i stula tract. (a) is identi /f_i ed in the intersphincteric space. (c) The /f_i stula tract is divided between right-angled forceps and trans /f_i xed with 2/0 vicryl sutures. (d) /uni00A0 Wound closure and intact tract ligation is con /f_i rmed with a probe (courtesy of Mr Rory Kennelly, FRCSI, Dublin, Ireland). Are classi /f_i ed according to the relationship to the anal sphincters The majority are simple and may be safely treated by /f_i stulotomy Complex /f_i stulae require detailed anatomical assessment that may include MRI Staged treatment including use of setons should be considered LIFT, /f_l ap advancement, VAAFT, FiLaC and OTSC allow sphincter preservation Biological therapy is used in multimodality treatment of /f_i stulae associated with Crohn’s disease