Evidence outside the box: Minimally invasive treatment for anal fistula

Table 1 Comparative studies with video-assisted fistula treatment

Ref.	Studies	Sample size	Follow-up duration	Surgical outcomes	P value	Functional outcomes	P value
Zheng et al[21], 2018	VAAFT vs fistula resection plus seton	87 (high fistulae 73.8% vs 82.2%)	> 6 months	Recurrence: 7.1% vs 15.6%	0.317	Visual analogue scale for pain: 2.9 vs 7.3; Hospital stays: 4.1 days vs 7.5 days; Faecal incontinence: 2.4% vs 20.0%	0.000; 0.000; 0.015
Liu et al[22], 2020	VAAFT vs fistulotomy plus seton	148 (high fistulae 75% vs 70%; trans-sphincteric 57.4% vs 52.5%)	1 year	Healing: 84.4% vs 82.8%; Recurrence: 15.6% vs 17.2%	1.000; 1.000	Postoperative pain: 2.9 vs 4.4; Postoperative stay: 6.8 vs 5.0; Wexner incontinence score: 0.9 vs 1.9	< 0.001; < 0.001; 0.003
Sørensen et al[23], 2021	VAAFT vs fistulectomy and sphincter repair	47 (anterior fistulae 52% vs 64%, Crohn’s 0%)	6 months	Recurrence: 65% vs 27%	0.016	Faecal incontinence: (1) Wexner score: Improvement in both groups; and (2) Manometry: Decrease in both groups	0.011 vs 0.022; NS vs 0.018
La Torre et al[24], 2020	VAAFT vs LIFT	54; (all high trans-sphincteric fistulae)	1.5 years	Failure: 14.2% vs 19.2%; 9.1% vs 50% (abscess group); recurrence: 39.2% vs 42%; 11% vs 70% (abscess group)	NS; < 0.05; NS; < 0.05	Visual analogue scale for pain: 2.75 vs 2.65; Faecal incontinence: (1) CCFIS: 2.8 vs 3; (2) Visual analogue scale: 2.7 vs 2.6; and (3) Manometry: 28.7 vs 27.5 (resting); 95.6 vs 95.8 (squeeze)	NS; NS; NS; NS; NS

VAAFT: Video-assisted fistula treatment; NS: Not significant; CCFIS: Cleveland Clinc Fecal Incontinence Score.