N

Age

G

Initial diagnosis

Previous treatment

Interval from previous treatment

Symptoms

MRI

Treatments

Results

Notes

Case 1

39

M

High extra-sphincteric perianal abscess, localized along left side of supra levator ani

Since 2016 multiple surgical drainage and seton position, supported by endoanal US at another hospital

Several years up to 5y.                                 4 months from the last procedure in another hospital

Pus discharge e severe pain

“horse-shoe” anal fistula, with internal orifice localized at midline posterior site of dentate line and deep extension in ischio-anal space bilaterally

VAAFT procedure and advancement mucosal flap to cover internal orifice

Recurrence

VAAFT

4 months

Pus discharge

2° VAAFT procedure and advancement mucosal flap to cover internal orifice

Recurrence

VAAFT

4 months

Pus discharge from the internal orifice

Combined approach of VAAFT plus Lipogems® injection in the fistula tract and the ischio-anal space, harvesting fat from abdomen

No recurrence was observed at two-years follow-up.

Case 2

48

M

Complex perianal fistula with ascending pararectal and trans sphincter pathway

Fistulectoma and seton positioning

12 months

Pus discharge e severe pain

Large transphinteric fistulous pathway with origin at 5 o'clock of the anus in the caudal course and with cutaneous orifice at the left intergluteal level

2° Fistulectoma and seton positioning

Recurrence

Very low compliance

Fistulectoma and seton positioning

5 months

Pus discharge

2° Fistulectoma and mucosal flap

Recurrence

2° Fistulectoma and mucosal flap

8 months

Severe pain

Abscess dreinage

Recurrence

Abscess dreinage

3 month

Pus discharge

VAAFT procedure and new  mucosal flap to cover internal orifice

Recurrence

VAAFT procedure and new  mucosal flap to cover internal orifice

10 months

Pus discharge

LIFT and third mucosal flap

Recurrence

LIFT and third mucosal flap

3 month

Pus discharge

Combined approach of VAAFT plus Lipogems® injection harvesting fat from abdomen, mucosal flap

Recurrence

Combined approach of VAAFT plus Lipogems® injection harvesting fat from abdomen, mucosal flap

5 months

Pus discharge

Seton positioning

Recurrence

Seton positioning

3 month

Pus discharge

VAAFT procedure and new  mucosal flap to cover internal orifice + Permacol placement

Lost at follow up

Case 3

54

M

Relapsing anal abscesses with double transphinteric and intersphincteric fistula up to the intergluteal fold and with two cutaneous orifices

Multiple abscess dreinage

Several years up to 15y

Pus discharge e severe pain

Fistulous pathway with origin in the anus at 6 o'clock and which goes beyond the internal anal sphincter and divides into two branches, one with a transphinteric course that connects to an abscess in the intergluteal area, with a cutaneous orifice and the second with an inter-sphincter course up to the fold intergluetea with second cutaneous orifice

Seton positioning

Recurrence

Seton positioning

4 months

Pus discharge

VAAFT procedure and new  mio- mucosal flap to cover internal orifice + Permacol placement

Recurrence

VAAFT procedure and new  mio- mucosal flap to cover internal orifice + Permacol placement

6 month

Pus discharge e severe pain

Combined approach of VAAFT plus Lipogems® injection harvesting fat from abdomen, mucosal flap

No recurrence was observed at one year follow-up.