VAAFT procedure for fistula

At a glance

VAAFT (video-assisted anal fistula treatment) is a relatively newer surgical approach to treating anal fistulas. It uses a tiny camera inserted into the fistula tract to visualise and treat it from the inside, without cutting through the sphincter muscle. This makes it one of several “sphincter-sparing” techniques available for fistula treatment.

How it works

The VAAFT procedure involves several steps:

1. Fistuloscopy — a thin, rigid camera (fistuloscope) is inserted into the external opening of the fistula tract
2. Visualisation — the camera allows the surgeon to see the inside of the tract, identify any branching or complexity, and locate the internal opening
3. Treatment — the lining of the tract is destroyed, typically using cautery (burning) delivered through the fistuloscope. This damages the tract lining so that healing can occur.
4. Closure — the internal opening is closed, often with a stapler or sutures, to prevent stool from entering the treated tract
5. External wound — the external opening may be left open to drain, or may be partially closed

The entire procedure is performed under anaesthesia and typically takes thirty to sixty minutes.

Who it is for

VAAFT is generally considered when:

• The fistula involves significant sphincter muscle and fistulotomy would risk continence
• The fistula is recurrent and previous surgery has already reduced sphincter function
• The patient specifically wants a sphincter-sparing approach
• The anatomy is suitable — VAAFT works best when the tract is relatively straight and accessible

It may not be suitable for:

• Very short, simple fistulas where fistulotomy is straightforward and low-risk
• Highly complex fistulas with multiple branching tracts
• Active, uncontrolled infection

What people describe about the experience

Before the procedure

People describe the pre-operative experience as similar to other fistula surgeries — pre-operative assessment, anaesthesia discussion, and practical preparation (stool softeners, time off work, wound care supplies).

The procedure

Most people describe the procedure as shorter than expected and the immediate post-operative pain as less severe than fistulotomy. The smaller wound and absence of sphincter division mean less tissue disruption.

Recovery

People describe:

• Less pain than after fistulotomy
• A smaller external wound with less drainage
• Faster return to daily activities — some people return to desk work within a week
• Continued need for wound care and monitoring, though less intensive than after fistulotomy
• Follow-up appointments to monitor healing and check for recurrence

The recurrence question

The main concern with VAAFT — and the reason it is not universally adopted — is that recurrence rates are higher than for fistulotomy. Not all treated fistulas stay healed. Some people describe the fistula returning weeks or months after VAAFT, requiring further treatment.

This trade-off — lower risk to continence but higher risk of recurrence — is the central consideration in choosing VAAFT. For many people, particularly those with complex fistulas, the sphincter preservation is worth the slightly higher recurrence risk.

The broader treatment landscape

VAAFT is one of several sphincter-sparing options for fistula treatment. Others include:

• LIFT procedure (ligation of the intersphincteric fistula tract)
• Advancement flap (covering the internal opening with a flap of rectal tissue)
• FiLaC (laser closure of the fistula tract)
• Fibrin glue or fistula plug (biological materials to seal the tract)

Each has its own success rates, recovery profiles, and suitability criteria. The choice between them depends on the fistula anatomy, the surgeon’s expertise, and the patient’s priorities. Discussing the available options with your surgical team is the best way to determine which approach is most appropriate for your specific situation.