A technical note of flex video-assisted anal fistula treatment procedure: Utilizing modified flexible fistuloscope in video-assisted approach for anal fistula laser treatment

This study explores an innovative approach for managing complex anal fistulas, known as the flexible video-assisted anal fistula treatment (flex-VAAFT). This technique uses a modified flexible fistuloscope and a laser diode for precise laser ablation. The flexible fistuloscope offers a wider field of view compared to the traditional VAAFT fistuloscope, allowing for better visualization and accurate assessment of the fistula tract's internal anatomy, enabling meticulous debridement and irrigation. We applied the flex-VAAFT approach in seven male patients aged 36 to 66, documenting the external and internal openings, etiology, and fistula type. Seton placement was used in one case, with follow-up periods ranging from 6 to 12 months. Most patients experienced successful healing, with only one recurrence observed. There were no cases of anal incontinence, and the average hospital stay was brief, lasting between 1 and 2 days. The findings suggest that flex-VAAFT is a promising, minimally invasive method for treating anal fistulas, enhancing surgical precision while preserving anal continence.