High failure rates following ligation of the intersphincteric fistula tract for transsphincteric anal fistulas: are preoperative MRI measurements of the fistula tract predictive of outcome?

Abstract

Aim: Treatment of transsphincteric fistulas (TSFs) with fistulotomy after an indwelling seton is tempered by risks of incontinence and litigation. Thus, ligation of the TSF tract has been popularized as an alternative option. We previously reported on 107 patients who underwent ligation of the intersphincteric fistula tract (LIFT), with a 46% failure rate.Posterior fistula was the only predictor of recurrence. The aim of the present work was to investigate whether the length, width or depth of the fistula measured on preoperative MRI was correlated with recurrence.Method: Following institutional review board approval, a retrospective analysis of our prospective Complex Anal Fistula Database from 1 January 2011 to 31 August 2019 was performed. Patients with TSF who underwent preoperative MRI and LIFT were included.Fistula location was classified as anterior, posterior or lateral. MRI measurements of fistula length, width and depth (in the intersphincteric groove) were performed. The type and rate of postoperative recurrence were analysed.Results: 173 patients underwent MRI for an anal fistula; of these 40 underwent LIFT and 22/40 (55%) had preoperative MRI. There was no difference in the length, width or depth of anterior (n = 9), posterior (n = 7) or lateral (n = 6) fistula tracts. The overall recurrence rate was 9/22 (41%). Posterior TSFs had the highest recurrence rate (5/7, 71%). Conclusion:The mean length, width, and depth of the fistula tract, measured at the preoperative site of LIFT in the intersphincteric groove, did not correlate with recurrence regardless of fistula location.

Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas

“…Correspondingly, the SPF procedure can integrally dissect the intersphincteric tract via cutting it off adjacent to the internal anal sphincter to increase operating space. Given that posterior transsphincteric fistulas treated by LIFT had a high recurrence rate of 71%, most posterior fistulas in this study were treated with SPF ( 22 ). It is believed that LIFT is technically demanding and difficult to perform in very high complex anal fistulas, especially for suprasphincteric and extrasphincteric fistulas ( 23 ).…”

¿Es la técnica de la ligadura del trayecto fistuloso interesfintérico (LIFT) la mejor alternativa para el tratamiento de la fístula anorrectal compleja?

“…Estas cifras de curación del LIFT no se repiten en la mayoría de las series publicadas en el mundo occidental. Una revisión retrospectiva de la Cleveland Clinic de Weston (n = 22) muestra una recidiva global del 41%, cifra que sube al 71% en las FA de localización posterior 17 . En un estudio retrospectivo de 268 pacientes en Holanda, la técnica LIFT efectuada en 45 casos mostró una recurrencia de 60% 18 .…”

Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

“…As stated before, preoperative MRI is done in quite a few patients with AF to aid in diagnosis and treatment. Few studies have directly investigated its role in predicting the long‐term outcome of treatment using both anatomic items and fistula activity 16–18 . Furthermore, less information is available regarding the predictive value of postoperative MRI 19 .…”

“…Few studies have directly investigated its role in predicting the long‐term outcome of treatment using both anatomic items and fistula activity. 16 , 17 , 18 Furthermore, less information is available regarding the predictive value of postoperative MRI. 19 Hitherto, to our knowledge, there is no existing systematic review to assess and compare the findings of these studies altogether.…”