{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:57:40Z","timestamp":1792443460050,"version":"4.5.0"},"reference-count":19,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Complex anal fistula represents a burden for patients, and its management is a challenge for surgeons. Video\u2010assisted anal fistula treatment (VAAFT) is one sphincter\u2010sparing technique. However, data on its long\u2010term effectiveness are scant. We aimed to explore the outcomes of VAAFT in a retrospective cohort of patients referred to a tertiary centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Consecutive adult patients with a minimum of 2\u2009years\u2019 follow\u2010up after VAAFT were reviewed. Patients were followed up to 5\u2009years postoperatively. Failure was defined as incomplete healing of the external orifice(s) during the first 6\u2009months. Recurrence was defined as new radiologically and\/or clinically confirmed onset of the fistula after primary healing. A generalized linear model was fitted to evaluate the association between failure and sociodemographic characteristics. Predictors of recurrence were determined in a subgroup analysis of patients found to be free from disease at 6\u2009months postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 106 patients (70% male; mean age 41\u2009years) were reviewed. Of these 86% had a previous seton placement. Fistulas were either high trans\u2010sphincteric (74%), suprasphincteric (12%) or extrasphincteric (13%). Eight (7%) patients experienced postoperative complications, none of which required reintervention. Mean follow\u2010up was 53\u2009\u00b1\u200913.2\u2009months. VAAFT failed in 14 (13%) patients. The overall recurrence rate ranged from 29% at 1\u2009year to 63% at 5\u2009years. Multiple external orifices, suprasphincteric fistula, younger age, previous surgery and higher complexity of the fistulous tract were independent risk factors for recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>VAAFT is a safe sphincter\u2010sparing technique. The initially high success rate decreases over time and relates to a higher degree of complexity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16732","type":"journal-article","created":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T05:10:15Z","timestamp":1693631415000},"page":"2017-2023","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Long term results of video\u2010assisted anal fistula treatment for complex anal fistula: another shattered dream?"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-6120","authenticated-orcid":false,"given":"Marco","family":"La\u00a0Torre","sequence":"first","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Goglia","sequence":"additional","affiliation":[{"name":"Department of General Surgery Sant'Andrea University Hospital, Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Micarelli","sequence":"additional","affiliation":[{"name":"ITER Centre for Balance and Rehabilitation Research (ICBRR)  Rome Italy"},{"name":"Eurac Research Institute of Mountain Emergency Medicine  Bolzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Fiori","sequence":"additional","affiliation":[{"name":"Department of Surgery Ospedale Figlie di San Camillo Vannini  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"D'Andrea","sequence":"additional","affiliation":[{"name":"Department of Surgery Ospedale Grassi di Ostia  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5372-2873","authenticated-orcid":false,"given":"Ugo","family":"Grossi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology \u2013 DISCOG University of Padua  Padua Italy"},{"name":"Surgery Unit 2 Regional Hospital Treviso, AULSS2 Marca Trevigiana  Treviso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone Maria","family":"Tierno","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Tomassini","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1066-4671","authenticated-orcid":false,"given":"Gaetano","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Surgery Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-022-02614-z"},{"issue":"1","key":"e_1_2_13_3_1","first-page":"1","article-title":"Prevalence of anal fistulas: a systematic review and meta\u2010analysis","volume":"15","author":"Sarveazad A","year":"2022","journal-title":"Gastroenterol Hepatol Bed 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