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| Name | VAAFT+LIFT Dr Kushal Mital |
| Video Uploader | Video From Dr. Kushal Mital |
| Upload Date | This Video Uploaded At 05-02-2014 22:21:27 |
| Video Discription | :VAAFT+LIFT to improve Fistula Surgery outcomes. Background: Both VAAFT (Video Assisted Anal Fistula Surgery) and LIFT (Ligation of Intersphincteric Fistula Tract)are newer surgical techniques for treatment of Fistula in Ano. Initial results were favourable, but were not replicable in other centers. In VAAFT and LIFT the favourable positive factor has been avoidance of Anal Sphincter injury. Hence improving outcomes could result only by modifying the original technique. Methods: all patients with fistula surgery were examined, those with short transphincteric fistula, or subcutaneous fistula or with only extrasphincteric fisluta were exclude, All patients with long transphincteric tracks were operated. Step 1: all patients were subjected to diagnostic fistuloscopy by Meinero's fistuloscope , aim to find the direction of tract, the internal opening, and secondary tracts. Once internal opening isolated, 3/0 Vicryl stay suture (2) taken at internal fistula opening. Step 2: Identification of intersphincteric groove. From external to internal opening. Hegar dilator size 1.5 inserted into tract. Then 2ml of 2% Xylocaine and adrenaline (1: 200000) injected subcutaneously at intesphinteric groove. Curvilinear incision along intersphincteric groove 1cm on each side of Hegar dilator. Gradual dissectiAimon and separation of intersphincter region then the with isolation of fistula track. Track is tied at external (E) and internal anal sphincter (I) ends in intersphincteric region and cut with No.15 blade. The external tie E is buried by a transfixing suture into external sphincter. The Internal sphincter end of cut tract is dissected upto anal submucosa. This tissue containing anal gland is sent for HPE. The submucosa approximated with 4.0 Vicryl suture. Saline is pushed through to lest efficacy of closure in intersphincteric external sphincter end. If leakage then reinforcing suture given. Closure of intersphincteric plane. Step 3: reinsertion of fistuloscope into external fistula opening. Cauterization of the fistula walls circumferentially. Brushing and curettage is done. Excision of a 2 mm margin at the external fistula opening, specimen is sent for biopsy. Dramatic improvement of result. Results: Total 42 cases done. No recurrence at 6 month period. Cases were selective, those with long transphincteric tract. Delayed healing of curvilinear incision in 2 patients, continued discharge at external fistula opening in 3 cases (8 weeks to heal). Conclusion: VAAFT and Lift are excellent newer techniques, wherein the anal sphincteric muscles are spared. In VAAFT the surgery involves treating the fistula from within and LIFT involves ligating the fistula tract in the inter plane. Recurrance is seen in both groups, approximately 24 % in VAAFT and 10% in LIFT by the originators of the procedure. However if both surgery are combined, then they are complimentary to each other. The result is a more effective treatment and a lower recurrence rate. Best of both techniques. |
| Category | Education |
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