Long-term results of ligation of intersphincteric fistula tract (LIFT) for management of anal fistula

Abstract

Background Ligation of intersphincteric fistula tract technique is a new sphincter saving method with good results in management of anal fistula, but few studies report long-term follow-up data. Material and methods This study investigated the use of ligation of intersphincteric fistula tract as a sphincter saving method based on long term results. This was a retrospective review of prospectively collected data. The study was conducted at two tertiary care university medical centers. 36 patients with complex fistula from January 2010 to January 2014 treated with classic ligation of intersphincteric fistula tract were retrospectively followed. Demographic data, previous repair attempts, the type of the fistula and score of fecal continence were collected. The procedure was performed by colorectal surgeons. Primary healing rate, failures and fecal incontinence score of patients were followed for 6–48 months. Results A total of 36 patients underwent ligation of intersphincteric fistula tract during 24 months. The mean age of the patients was 35 years and 50% had two previous attempts at surgery. A total of 25 patients (69/5%) had high transsphincteric fistula. The mean follow up was 27 months. Successful fistula closure was achieved in 63/8% of the patients (23 of 36). The mean time of recurrence was 4.5 weeks. Only one (2/77%) patient reported gas incontinence (score: 3) after the procedure. Conclusion The recurrence rate and fecal incontinence were measured. The ligation of intersphincteric fistula is a promising sphincter-preserving procedure that is simple and safe. Our study demonstrates favorable long-term results of ligation of intersphincteric fistula tract for management of complex anal fistulas.

Ligation of the Intersphincteric Fistula Tract (LIFT) Technique in the Treatment of Complex Perianal Fistula: Experience of First 50 Cases

“…In these patients LIFT seems a promising option because there is negligible trauma to the sphincter and the present study only included patients with complex fistula. The fistulas for which LIFT has been done in most of the series are also complex fistula 4,5,[8][9][10][11][12][13][14] .…”

“…There is no strong evidence regarding the optimal way to perform LIFT. Parthasarathi R et al 9 used prone operative position in their series but most of author used lithotomy position for LIFT operation 4,5,18,19 . In our series, we used lithotomy position where the external opening of fistula lies anteriorly and prone jackknife with the buttocks strapped apart where the external opening of fistula lies posteriorly.…”

“…Complex fistulas include high transsphincteric (>30% of external sphincter involvement), suprasphincteric or extrasphincteric fistulas. They may also be defined as horse shoe, recurrent and all anterior fistulas in woman and may also present with multiple tract or associated to Crohn's disease, radiation therapy or malignancy 3,4 .…”

Fistula in ano: open method compared to lift method ligation of intersphincteric fistula track

“…7 This study investigated the use of ligation of intersphincteric fistula tract as a sphincter saving method based on long term results. The study was conducted at two tertiary care university medical centers.…”

Ligation of the intersphincteric fistula tract technique in the treatment of anal fistula

“…3 Anal fistulas were classified also into simple and complex, treatment of complex fistulas usually associated with a high risk of incontinence or recurrence, a fistula is termed complex when the tract crosses more than 30 % of the external anal sphincter (this include hightranssphincteric, suprasphincteric, and extrasphincteric types in Parks classification) also fistula is considered complex if it is recurrent or has multiple tracts, anterior fistulas in females and fistulas in patients has pre-existing incontinence or local disease as Crohn's disease, TB or local irradiation. 4,5 Treatment of anal fistula depends on the amount of anal sphincter involvement and sphincter preservation to maintain continence. Traditionally anal fistulas were treated by fistulotomy or fistulectomy, which have both proven to be effective, however, even for simple fistulas, they may result in some degree of incontinence in approximately 12%-39% of patients, need prolonged time for wound healing and associated with postoperative scaring and anal deformity.…”