- A video telescope (Futuroscope) to allow surgeons to see inside the fistula tract. A unipolar
- electrode for diathermy of the internal tract. This is connected to a high-frequency generator.
- A fistula brush and forceps for cleaning the track and clearing any granulation tissue.
The VAAFT procedure is done in 2 phases, diagnostic and operative. Before the procedure, the patient is given a spinal or general anaesthetic and is placed in the lithotomy position (legs in stirrups with the perineum at the edge of the table).
In the diagnostic phase, the Futuroscope is inserted into the fistula to locate the internal opening in the anus and to identify any secondary tracts or abscess cavities. The anal canal is held open using a speculum and irrigation solution is used to give a clear view of the fistula tract. Light from the Futuroscope can be seen from inside the anal canal at the location of the internal opening of the fistula, which helps to locate the internal opening.
In the operative phase of the procedure, the fistula tract is cleaned and the internal opening of the fistula is sealed. To do this, the surgeon uses the unipolar electrode, under video guidance, to cauterise material in the fistula tract. Necrotic material is removed at the same time using the fistula brush and forceps, as well as by continuous irrigation. The surgeon then closes the internal opening from inside the anal canal using stitches and staples.