One of five fistula operations · see all techniques
VAAFT (Video-Assisted Anal Fistula Treatment): camera-guided, sphincter-saving
VAAFT passes a fine camera (fistuloscope) along the fistula tract to see the tunnel, its branches and the internal opening from inside, then seals it with electrocautery and closes the internal opening — without cutting sphincter. It suits complex or branched tracts where the internal opening is unclear. Day-care; desk work in 3–7 days (results vary). Performed by Dr. Kundan Kharde at Sharvari Hospital, Pimple Nilakh, Pune — 5 min from Wakad.
Who is this operation for?
VAAFT is chosen when the scan shows a tract that is branched, long or recurrent, or when the internal opening cannot be found confidently on examination — the cases where a blind procedure misses a branch and the fistula returns. It belongs in the deep-tract and staged rows of Dr. Kharde's framework, often after a seton has settled infection. Almost every fistula at Sharvari Hospital is imaged before surgery — MRI fistulogram or trans-rectal ultrasound — and the tract on that scan decides the operation (how Dr. Kharde decides).
How is it done?
- Anaesthesia. Spinal or general anaesthesia, lithotomy position.
- Fistuloscopy. A 3.3 mm rigid fistuloscope with continuous irrigation is passed through the external opening and advanced along the tract under direct vision.
- Mapping. The tract, its side branches and any pus pocket are inspected on screen; the light seen inside the anal canal pinpoints the internal opening.
- Sealing. A monopolar electrode is drawn back along the tract to destroy its lining; debris is cleared with an endoscopic brush.
- Internal opening closure. Closed with a suture or small mucosal flap; the external opening is left to drain. No sphincter muscle is divided.
About 45–60 minutes · no incision beyond the existing external opening · both sphincters preserved.
What does recovery look like?
| Day | Discharge & follow-up | Dressing & bowel movement | Return to work |
|---|---|---|---|
| Day 1 | Same-day discharge after observation; walking and normal diet that evening. | Light dressing on the external opening; sitz-bath routine taught; first bowel movement next day with a stool softener. | Rest at home; antibiotics and painkillers as prescribed. |
| Day 7 | Free first review at the hospital. | Twice-daily sitz baths; some discharge from the external opening is normal. | Desk work from Day 3–7; no gym or long sitting yet (results vary). |
| Day 30 | Healing review; MRI if healing is slow. | External opening closed or closing; continence unchanged. | Resume gym, cycling and long sitting. |
Same 30-day roadmap as the main fistula page. Results vary.
What are the risks and the alternatives?
- •Bleeding: minor spotting is usual; heavy bleeding is uncommon and is an emergency (we are open 24×7).
- •Infection: fever, rising pain or new swelling needs review; antibiotics are prescribed routinely.
- •Non-healing or recurrence: published series report healing in roughly 70–80% of selected complex tracts (literature range, not Sharvari data). Most failures are at the internal opening, which is why its closure matters as much as the camera. Results depend on tract anatomy.
- •Continence change: very low risk — nothing is cut through the sphincter; the tract is treated from within.
- • Alternatives: Fistulotomy / fistulectomy, LIFT, FiLaC (laser), Seton (staged) — the imaging decides which.
Technique selection follows the ASCRS Clinical Practice Guideline for Anorectal Abscess, Fistula-in-Ano and Rectovaginal Fistula (2022).
How does VAAFT compare?
VAAFT trades a longer operation for the ability to see and treat branches that a blind technique would miss.
| Technique | Best for | Sphincter cut? | Day-care? | Typical return to desk work | Published healing range* | Recurrence risk |
|---|---|---|---|---|---|---|
| Fistulotomy / fistulectomy | Simple, superficial tract, <30% sphincter | Yes, minimal | Yes | 3–7 days | ~90–95% | Low |
| LIFT | Trans-sphincteric tract; intact sphincter needed | No | Yes | 5–10 days | ~60–80% | Moderate |
| FiLaC (laser) | Trans-sphincteric tract; patient wants no cut | No | Yes | 2–5 days | ~60–70% | Moderate |
| VAAFT (this page) | Complex / branched tract, unclear internal opening | No | Yes | 3–7 days | ~70–80% | Moderate |
| Seton (staged) | Active sepsis; high / recurrent / horseshoe; Crohn's | No (drainage) | Yes (stage 1) | 2–5 days per stage | Bridge to definitive operation | n/a |
*Published literature ranges, not Sharvari outcome data; results vary and depend on tract anatomy.
Why have it at Sharvari Hospital?
- ✓Routine pre-operative imaging — MRI fistulogram or trans-rectal ultrasound for almost every fistula.
- ✓Same surgeon consults and operates — Dr. Kundan Kharde, MS, FMAS, 19+ years, 6,000+ surgeries (Dr Kharde's fistula profile).
- ✓Our own 50-bed hospital, open 24×7 — in-house beds if anything needs observation.
- ✓Cashless with 50+ insurers — pre-authorisation by our TPA desk. ISO 9001:2015 · PCMC Reg. 884.
Frequently asked questions
When is VAAFT chosen over FiLaC? +
When the tract needs to be seen, not just sealed. A single, straight, mature tract with an obvious internal opening suits FiLaC. A branched, long or recurrent tract, or one whose internal opening is uncertain, suits VAAFT because the camera finds the branches and the opening first. The MRI usually makes this choice clear.
Can VAAFT find the internal opening? +
Yes — that is its main advantage. The fistuloscope light is seen from inside the anal canal exactly where the tract opens, so the internal opening is confirmed under direct vision rather than guessed with a probe. A missed internal opening is the commonest reason fistulas recur.
Does VAAFT need a cut? +
No skin incision and no sphincter division. The scope enters through the external opening that already exists. The only "cut" is the closure of the internal opening inside the anal canal, done with a stitch or a small mucosal flap. Post-operative pain is therefore usually mild, though experience varies.
What is recovery after VAAFT like? +
Day-care in most cases. Expect some discharge from the external opening for one to two weeks, twice-daily sitz baths, and a free wound review on Day 7. Desk work is usually possible within 3–7 days; gym after the Day 30 review. Results vary with tract length and whether a seton stage came first.
Can VAAFT be combined with other techniques? +
Yes. In a staged plan a seton drains the tract first and VAAFT is the definitive step. It can also be combined with laser closure of a branch, or a proximal fistulotomy when part of the tract is superficial. The combination is chosen from the imaging, not a fixed package.
Cost, insurance and beds: see the full fistula treatment page.
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