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

Abstract

Background: To compare fistula in ano open method with lift method ligation of intersphincteric fistula track.Methods: This is a prospective study which consisted of 70 patients suffering from fistula-in-ano who were admitted to surgery department. All patients above 18 years of age, cases of transsphincteric low anal fistula, maturation of tract were included in the study. Results: In this study, 60 patients were included totally, of which, 10 patients were excluded as 5 patients had tuberculosis, 2 had Crohn's disease and 3 were excluded as they lost follow up. Hence, 50 patients were included in the study. 40 were males and 10 were females with a male to female ratio of 4:1 in this study. The average age of fistula in ano was 45.34±10.39 years. The incidence of fistula in ano was maximum in the age group of 46-55 years. The minimum incidence was in the age < 30 years. The most common primary fistula is intersphincteric track (46%), followed by transsphincteric track (42%). The most common type of fistula in ano patients was discharge from the tract which was in all patients, in others, perianal pain and bleeding was observed. Fistula in ano can be divided into low and high level of fistula. High level of fistula-in-ano was found in 64 % of patients and low level of fistula-in-ano was found in 36% of patients. Recurrence was seen in 6 patients with high suprasphincteric track who were ligated below the internal opening and 10 patients had a recurrence with transsphincteric track of which 6 were obese which made identifying the fistula track difficult. Conclusions: The LIFT procedure is advantageous as no chance of incontinence prevails as the infective focus is removed without dividing any part of sphincter complex, other advantages are that it is easy to learn, perform, safe, high healing rate, low morbidity and easily treat fistula in ano at primary health care level.