Ligation of Intersphincteric Fistula Tract for Fistula in Ano: Lessons Learned From a Decade of Experience

Malakorn, Songphol; Sammour, Tarik; Khomvilai, Supakij; Chowchankit, Irin; Gunarasa, Shankar; Kanjanasilp, Prapon; Thiptanakij, Charnjiroj; Rojanasakul, Arun

doi:10.1097/dcr.0000000000000880

Cited by 57 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may be explained by first, LIFT has been a preferred technique for complex and recurrent fistula which, by themselves, is considered a poor prognostic factor for clinical outcome. Second, the report on long-term result of LIFT shows that the healing rate for high transsphincteric (60%), semihorseshoe (89%) and horseshoe (40%) fistulas was not as good as the simple types 41…”

Section: Discussionmentioning

confidence: 99%

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Tantiphlachiva

Sahakitrungruang

Rojanasakul

2019

BMJ Open Gastroenterol

Self Cite

View full text Add to dashboard Cite

ObjectiveEndoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.DesignRetrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of <0.05 is considered significant.Results We enrolled 339 subjects; 109 (M:F 91:18, mean age 41.7±13.6 years) of 115 in EAUS group and 230 in no-EAUS group (M:F 195:35, mean age 42.6±13.0 years). There were higher proportions of recurrent cases (24.8% vs 13.9%, p=0.014) and complex FiA (80.7% vs 50.4%, p=0.001) in EAUS group. Postoperative FISS (mean±SE) were increased in both groups; preoperative versus postoperative FISS were 0.36±0.20 versus 0.59±0.25 in EAUS group (p=0.056) and 0.31±0.12 versus 0.76±0.17 in no-EAUS group (p<0.001). EAUS had significant effects on cFISS in both univariate analysis, F(1,261)=4.053, p=0.045; and multivariate analysis, F(3,322)=3.147, p=0.025, Wilk’s Lambda 0.972. Other associated factors included recurrent fistula (F(3,322)=0.777, p=0.007, Wilk’s Lambda 0.993) and fistula classification (F(3,322)=16.978, p<0.001, Wilk’s Lambda 0.863). After a mean follow-up of 33.6±28.6 weeks, success rate was 63.3%(EAUS) and 60% (no-EAUS), p=0.822. Factors associated with clinical outcomes were fistula complexity, number of tracts, recurrence, number of previous surgery and type of operations. Accuracy of EAUS was 90.8% and not related to clinical outcomes (p=0.522).ConclusionEAUS had favourable effects on functional outcome after FiA surgery while multiple factors were associated with clinical outcomes. EAUS is useful, accurate, inexpensive and can be the first tool for planning of complex and recurrent FiA.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Tantiphlachiva

Sahakitrungruang

Rojanasakul

2019

BMJ Open Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Three of them developed postoperative sphincter fistula. The total success rate was 62.5%, superior to 40% of the horseshoe anal fistulas reported 13 . We believe the reason for our better result is the tunneled removal of the fistula, which reduces the recurrence induced by the residual fistula after conventional scraping and thread-drawing therapies.…”

Section: Discussionmentioning

confidence: 68%

Long-Term Outcomes of Ligation of Intersphincteric Fistula Tract for Complex Fistula-in-Ano: Modified Operative Procedure Experience

Wen

Sun

et al. 2018

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.

show abstract

“…In our study, we include only primary fistula of cryptogladular origin and exclude all recurrent fistula because we are new to this procedure. In many series they also included recurrent fistulas 9,14,[21][22][23] . Some authors conclude that recurrent fistula seems to be risk factor for the recurrence of fistula after LIFT procedure [21][22][23] while other states no difference in outcome when LIFT applied in primary versus recurrent fistula 9,14 .…”

Section: Discussionmentioning

confidence: 99%

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

Biswas¹,

Rahman²,

Hossain³

et al. 2020

Faridpur Med Coll J

View full text Add to dashboard Cite

Perianal fistula is a common disease and surgery is the only treatment option. Many surgical techniques have been described. Ligation of intersphincteric fistula tract (LIFT) is a sphincter saving surgical technique in which fistula tract is ligated and excised through intersphincteric approach. The aim of study is to present our experience of first 50 LIFT procedures particularly healing rate, recurrence rate and complications from the procedure. This is a prospective observational study started from March 2018 on whom underwent LIFT procedure for primary complex perianal fistula of infective origin at Faridpur Central Hospital and Faridpur Medical College Hospital. In this study, 50 patients (42 male and 8 female) of average age of 39±7.6 years with complex fistula were included. The mean operative time was 34.7±5.67 minutes and most of the fistulas were transsphincteric variety (90%). Median wound healing time was 21.45±6.34 days for intersphincteric wound and 26.78±6.93 days for the external opening of the fistula. Mean follow up period was 10.5 months. Seven patients of our series developed recurrent fistula, making the overall success of 86%. None of the patient in our series developed incontinence. LIFT procedure has the advantage of preservation of anal sphincter, minimal tissue injury, shorter healing time, relatively easy to perform, and high success rate. It's a good choice for treatment of complex perianal fistula. Faridpur Med. Coll. J. Jan 2020;15(1): 3-7

show abstract

Ligation of Intersphincteric Fistula Tract for Fistula in Ano: Lessons Learned From a Decade of Experience

Abstract: Ligation of intersphincteric fistula tract is an effective technique for the treatment of fistula in ano, including recurrent or unhealed fistula after other procedures. See Video Abstract at http://links.lww.com/DCR/A387.

Cited by 57 publications

References 32 publications

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Long-Term Outcomes of Ligation of Intersphincteric Fistula Tract for Complex Fistula-in-Ano: Modified Operative Procedure Experience

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

Contact Info

Product

Resources

About