Increasing experience of ligation of the intersphincteric fistula tract for patients with Crohn's disease: what have we learned?

Kamiński, Jan P.; Zaghiyan, Karen; Fleshner, Phillip

doi:10.1111/codi.13668

Cited by 59 publications

(33 citation statements)

References 23 publications

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“…Study and patient characteristics are shown in Table S1 (supporting information) , . Five studies were RCTs, six were prospective cohort studies and 19 were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

et al. 2019

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Background High perianal fistulas require sphincter‐preserving surgery because of the risk of faecal incontinence. The ligation of the intersphincteric fistula tract (LIFT) procedure preserves anal sphincter function and is an alternative to the endorectal advancement flap (AF). The aim of this study was to evaluate outcomes of these procedures in patients with cryptoglandular and Crohn's perianal fistulas. Methods A systematic literature search was performed using MEDLINE, Embase and the Cochrane Library. All RCTs, cohort studies and case series (more than 5 patients) describing one or both techniques were included. Main outcomes were overall success rate, recurrence and incontinence following either technique. A proportional meta‐analysis was performed using a random‐effects model. Results Some 30 studies comprising 1295 patients were included (AF, 797; LIFT, 498). For cryptoglandular fistula (1098 patients), there was no significant difference between AF and LIFT for weighted overall success (74·6 (95 per cent c.i. 65·6 to 83·7) versus 69·1 (53·9 to 84·3) per cent respectively) and recurrence (25·6 (4·7 to 46·4) versus 21·9 (14·8 to 29·0) per cent) rates. For Crohn's perianal fistula (64 patients), no significant differences were observed between AF and LIFT for overall success rate (61 (45 to 76) versus 53 per cent respectively), but data on recurrence were limited. Incontinence rates were significantly higher after AF compared with LIFT (7·8 (3·3 to 12·4) versus 1·6 (0·4 to 2·8) per cent). Conclusion Overall success and recurrence rates were not significantly different between the AF and LIFT procedure, but continence was better preserved after LIFT.

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“…Study and patient characteristics are shown in Table S1 (supporting information) , . Five studies were RCTs, six were prospective cohort studies and 19 were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

et al. 2019

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“…The same group recently presented the results of a retrospective analysis of a prospective database of 23 patients with CD who underwent the LIFT procedure, over a 58-month period 95. All patients were operated on by the same surgeon.…”

Section: Modern Surgical Techniques For Perianal Fistulas In CDmentioning

confidence: 99%

Modern management of perianal fistulas in Crohn’s disease: future directions

Kotze

Shen

Lightner

et al. 2018

Gut

130

104

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Perianal fistulae in patients with Crohn's disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.

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“…Recently, Kamiński et al reported on 23 patients who underwent LIFT, and had a healing rate of 48%. 8 This was a small series, but the only factor predicting better outcome was the presence of associated small bowel rather than colonic disease. Figg and Church noted that colonic disease is more likely to be associated with pCD and the relatively poor results reported by Kamiński et al may be at least in part explained by the presence of perineal Crohn's.…”

Section: Literature Reviewmentioning

confidence: 83%

Management of Complex Anorectal and Perianal Crohn's Disease

Bolshinsky

Church

2019

Clinics in Colon and Rectal Surgery

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Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues themselves. This key distinction should drive the investigation and management of anal and perianal symptoms in patients with Crohn's disease. In this review, the evaluation and management of the various manifestations of Crohn's disease in the perineum and perianal tissues will be described.

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Increasing experience of ligation of the intersphincteric fistula tract for patients with Crohn's disease: what have we learned?

Abstract: The LIFT procedure offers reasonable long-term success in the treatment of perianal trans-sphincteric fistulas associated with CD. LIFT is more likely to fail in patients with concurrent colonic CD than in patients with small bowel CD.

Cited by 59 publications

References 23 publications

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

Modern management of perianal fistulas in Crohn’s disease: future directions

Management of Complex Anorectal and Perianal Crohn's Disease

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