Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All specialist commentators were familiar with the technology and 1 stated that they used it on a regular basis.

Level of innovation

All specialist commentators stated that VAAFT is a novel technique, using existing equipment and methods in a way that has not previously been used to treat anal fistula. One noted that VAAFT was the only treatment that allowed visualisation inside the fistula, helping the surgeon locate and treat any secondary tracts. This could lead to improved healing rates compared with other techniques.

Potential patient impact

The potential patient benefits noted by the specialist commentators included a reduced risk of faecal incontinence, better understanding of the anatomy of the fistula and therefore full drainage of any pus or infection, reduction in post-operative pain and no loss of sphincter muscle function. They considered that VAAFT may be particularly useful for high fistulae and for people with recurrent fistulae due to Crohn's disease. One commentator stated that the use of VAAFT may mean fewer inpatient visits for these patients. Another was of the opinion that people having VAAFT may need more hospital visits than those having a fistula plug, but that this would be comparable to more invasive methods such as advancement flaps. All the specialist commentators felt that it is likely that patient benefits will be realised in practice. One noted that more studies are needed to provide evidence for the potential benefits, particularly long-term studies and patient questionnaires, ensuring that healing rates are measured.

Potential system impact

All the commentators agreed that use of VAAFT would require training, with 2 suggesting that this should be in the form of observation and mentoring with experienced users. One specialist commentator stated that VAAFT could reduce the need for MRI scans. Two felt that it would be a minimally invasive treatment option. Other benefits for the healthcare system cited by the specialist commentators included reduced follow-up and time to recovery and potentially fewer recurrences. One specialist commentator stated that use of VAAFT should be restricted to specialist units and should only be used as part of a clinical trial until more data are collected.

General comments

The specialist commentators were not aware of any safety issues associated with VAAFT. They stated that it may lead to savings for the NHS but that more evidence was needed.