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Page 1: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

Dr.Manoharan Nandakishore

General and Laproscopic SurgeonApollo Hospitals,Chennai

Prospective Analysis of 48 Consecutive Cases of VAAFT

Page 2: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

CONFLICT OF INTEREST

NONE

Page 3: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

AIM

To study the safety, efficacy and patient comfort factor in the treatment of fistula in ano with VAAFT.

Page 4: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

MATERIALS AND METHODS

This was a prospective study from August 2011 to February 2012 involving 48 patients, who had presented with fistula in ano.

Page 5: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

MATERIALS AND METHODS

9 patients – Low anal fistula

16 patients – Intersphincteric fistula

23 patients – Transsphincteric fistula

Page 6: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

RECURRENT FISTULA

6 of 16 Intersphincteric fistula

4 of 23 Transsphincteric fistula

Page 7: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

SPECIFIC INVESTIGATION

MR fistulogram For all intersphinteric and transsphinteric cases and two cases of low anal fistula.

Page 8: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

ANAESTHESIA

General Anaesthesia – 11 patients

Spinal Anaesthesia – 37 patients

Page 9: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

CLOSURE OF INTERNAL OPENING

32 patients

12 patients - Mucosal flap – 8 patients had

glue reinforcement

20 patients – Stapler + glue reinforcement

Page 10: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

PAIN SCORE

Score 1 - 11 patients Score 2 - 29 patients

Score 3 - 8 patients (GA)

Page 11: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

PRE OPERATIVE

Page 12: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

POST OPERATIVE

Page 13: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

LENGTH OF HOSPITAL STAY

26 patients – Day care

22 patients – 24 hours

Page 14: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

3 MONTHS POST OPERATIVE

Page 15: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

RECURRENCE

Page 16: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

RECURRENCE

Total 7

Low anal – 1 Intersphincteric -4 (2)Transsphincteric – 2(2)

Page 17: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

RETURN TO NORMALCY

100 % in 48 hours

Page 18: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

SPHINTER INCONTINENCE

NONE

Page 19: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

CONCLUSION

Safe

Effective

Low morbidity

Less Post operative pain

Better convalescence

Intact sphincter control

Less mutilating

Page 20: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT
Page 21: Dr.Manoharan Nandakishore General and Laproscopic Surgeon Apollo Hospitals,Chennai Prospective Analysis of 48 Consecutive Cases of VAAFT

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