Traditional surgery for complex anal fistulas often carries the risk of anal incontinence and recurrence, and therapeutic video-assisted (fistuloscopy) treatment of anal fistulas is a new endoscopic-assisted sphincter-preserving technique. A recent retrospective study from Italy over a 6-year period reported on the clinical outcomes of VAAFT fistuloscopy for the treatment of anal fistulas; from February 2006 to February 2012, 203 patients with complex anal fistulas of adenogenic origin were treated with VAAFT fistuloscopy; 139 of them had a history of surgical treatment of anal fistulas; fistulas were staged according to the PARKS staging, and video The procedure of assisted fistuloscopy can be divided into two parts: diagnostic and surgical; diagnostic procedure: exploration from the external opening of the fistula, identification of the main canal, possible fistula branches and pus cavity, and the internal opening; application of high-frequency electric knife to the wall tissue under the scope, removal of electrocoagulated tissue from the canal by the anal fistula brush, exploration along the canal lumen to the internal opening, incision and electrocoagulation of the internal opening, which can be partially closed by anastomosis; open fistula. Intraoperatively, in 121 cases (59.6%), the presence of branches and pus cavities was detected; the distribution of intraoperative exploration of the internal orifice was 152 (74.8%) at the dentate line, 36 (17%) at the anal canal, and 15 (7.4%) at the rectum; postoperatively, one patient had urinary retention and one had scrotal edema; the mean pain visualization score of the patients was 4; the follow-up was 15 months (6-69 months), postoperatively at 2, 4, 6, and 12, and 24 follow-up, the cumulative recurrence rate of patients in the survival analysis was 70% and no serious complications occurred. The results of this retrospective study suggest that video-assisted fistuloscopy is safe and effective in the treatment of complex anal fistulas, that it protects the patients’ anal function better, and that postoperative patient satisfaction and quality of life scores are better than those of conventional incisional surgery.