A prospective evaluation of the outcome of submucosal ligation of fistula tract

Abstract

Aim Fistula-in-ano (FIA) is an anomalous passage between perianal skin and the anal canal or the rectum that presents many management difficulties. Ligation of intersphincteric fistula tract (LIFT) was introduced as a cost-effective sphincter-saving procedure with a reported success rate of 94.4%. Unfortunately, this procedure is technically challenging, and recently submucosal ligation of fistula tract (SLOFT), a simplification of LIFT, was proposed. Our aim was to assess the SLOFT technique over a longer follow-up period to determine its effectiveness. Method A prospective observational study was performed in 47 patients with FIA treated by SLOFT from September 2017 to February 2019. Results There were 47 patients, of whom 33(70.2%) were men. The median age was 39 years (range 30-50 years). All the patients had primary FIA of cryptoglandular origin. The patients were followed up for 1 year and were postoperatively assessed at 2, 4, 12 and 24 weeks and 1 year. The median body mass index was 27.3 kg/m 2 (range 24.3-29.4 kg/m 2) and the median duration of surgery was 15 min (range 13-20 min). Most (83.0%) of the fistulas were trans-sphincteric. The success rates at the end of 24 weeks and 1 year were 87.2% and 80.9%, respectively. No postoperative incontinence was recorded. Conclusion In our series the success rate of SLOFT was 80.9%. There were no sphincter-related complications. Repeat SLOFT was feasible for cases of recurrence. Therefore, SLOFT should be considered an alternative sphincter-saving procedure to LIFT for the management of FIA. Keywords fistula-in-ano, SLOFT, sphincter-saving procedure What does this paper add to the literature? We describe a novel sphincter-saving technique for the management of fistula-in-ano (FIA) after a follow-up period of 1 year. This procedure is simpler than ligation of intersphincteric fistula tract (LIFT), and its results are comparable to those of LIFT. Hence, for surgeons, it serves as another treatment option for FIA.

‘Bumps down under:’ hemorrhoids, skin tags and all things perianal

“…Submucosal ligation of fistula tract (SLOFT), a modification of LIFT, is technically less difficult because it avoids dissection in the intersphincteric plane [26]. In an observational study of 47 patients undergoing SLOFT, the fistula closure success rate was 80.9% [27 ▪ ]. These data are encouraging and, given the greater simplicity of the approach compared to LIFT, might be considered as an alternative option to the LIFT procedure.…”

Novel SLOFT technique

“…The secure closure of the internal opening, disconnection of the tract and eradication of the distal tract are the governing principles of this procedure. While it is true that SLOFT does not tackle the sepsis within the intersphincteric tract, this was not reflected in the clinical outcome [3]. There are a variety of reasons for the failure of a sphincter sparing procedure including length of the tract, perianal collection and diabetes mellitus [4,5].…”