Objective To summarize the research progression of video-assisted anal fistula treatment (VAAFT). Methods The related literatures in recent years were reviewed, and then the operation principle, operation process, advantages and disadvantages, matters needing attention, and clinical application of VAAFT were summarized. Results VAAFT is the treatment of fistulas by endoscopy. It don’t require the incision or resection of the fistula. It has the advantages of less surgical trauma, faster postoperative recovery, and less impact on the anal sphincter. The disadvantage of this method is relatively strict indications, fistula bending or horseshoe fistula is not suitable for this method. In addition, the endoscope using during the operation is a rigid mirror tube, and the operation is not convenient enough, so technical improvement is needed in the future. We should pay attention to distinguish true fistula and false fistula in clinical practice; the wall of the fistula should be adequately burned and the necrotic tissue should be cleaned; the treatment of the internal opening of anal fistula must be exact; the time of the first defecation should be appropriately delayed, and the incidence of infection should be reduced after operation. At present, the clinical reports of VAAFT are increasing gradually in foreign countries, and these reports have achieved good therapeutic effect. It is considered that this method maybe a safe and effective minimally invasive surgical treatment for anal fistula. However, there is few clinical reports on VAAFT in China, and it is still in the preliminary stage of exploration. Conclusion VAAFT is a new technology in the treatment of anal fistula, and it has advantages of minimally invasive, sphincter preservation, and so on, which is worthy of clinical application.
Objective To systematically evaluate the efficacy and safety for video-assisted anal fistula therapy in the treatment of complex anal fistula. Methods The databases of CKNI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library and Embase were retrieved from the time of database establishment to may 31 2022. The two researchers independently screened the literatures and evaluated the quality of the literatures that met the inclusion criteria according to the research purpose and quality evaluation criteria. Meta-analysis were performed with the Revman 5.4.1 software. Results A total of 11 articles and 977 patients were included. The results of meta-analysis showed that the video-assisted group were superior to the traditional incision and thread hanging operation group in improved the cure rate [RR=1.14, 95%CI (1.04, 1.24), P<0.05], accelerated wound healing [MD=–10.40, 95%CI (–13.64, –7.17), P<0.05], protected the anal function after surgery [MD=–1.32, 95%CI (–1.85, –0.79), P＜0.05], relieved postoperative 24-hour pain [MD=–1.23, 95%CI (–1.60, –0.86), P＜0.05], shorten the operative time and hospital stay [MD=–9.46, 95%CI (–17.16, –1.75), P<0.05; MD=–3.87, 95%CI (–5.90, –1.84), P<0.05], reduced intraoperative bleeding [MD=–14.24, 95%CI (–17.49, –10.99), P<0.05] and the incidence of postoperative complications [RR=0.39, 95%CI (0.27, 0.56), P<0.05], which difference were statistically significant. However, there was no significant difference in the recurrence rate of 1-year after operation [OR=0.64, 95%CI (0.33, 1.23), P>0.05]. Conclusions Video-assisted anal fistula treatment is a safe and effective sphincter preserving operation for the treatment of complex anal fistula, which is superior to the traditional incision and thread hanging operation. However, due to the limitations and publication bias of the included literature, more prospective, large sample, multi center randomized controlled trial are needed to confirm its long-term efficacy.