Long‐term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas

Sun, Xuemei; Wen, Kai; Chen, Y.‐H.; Xu, Zhizhong; Wang, X.‐P.

doi:10.1111/codi.14405

Cited by 30 publications

(22 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sun X-L et al have also reported that the small size of the intersphincteric tract may also increase the risk of a technical error. 20 We could conclude that simple fistulas can be managed with fistulotomy rather than LIFT, but that might be oversimplification considering the sample size of our study.…”

Section: Discussionmentioning

confidence: 66%

“…19 Sun et al reported healing rate for high transsphincteric fistula-in-ano for mature and immature fistulas were 83.7% and 77.3%, respectively, with negligible impairment on continence on long term. 20 On analyzing the factors which affect healing of the fistula tract, we found that simple fistulas, fistulas with external opening within 3 cm, and intersphincteric fistulas were significantly associated with recurrence of fistula following LIFT (►Table 2). This can be explained on the basis of failure of ligation and identification of tract, immature tract, slippage of ligature and cases done early in our learning curve.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

The Ligation of the Intersphincteric Fistula Tract (LIFT) Technique for Simple and Complex Fistula-in-ano

Kumar

Arora

Ranjan

et al. 2021

Journal of Coloproctology

View full text Add to dashboard Cite

Background Fistula-in-ano is one of the most common clinical condition encountered in a surgical outpatient department. Many treatment modalities have been described with variable outcomes but gold standard surgical treatment is yet to be agreed upon. The aim of the present study is to evaluate the treatment outcomes of ligature of intersphincteric fistula tract (LIFT) technique in the treatment of simple and complex fistula-in-ano with the primary objective of recurrence rate and broad objective of other postoperative complications during the period of study and after long-term follow-up. Methods It is a retrospective study of prospectively collected data from the patients who have been operated for fistula-in-ano using the LIFT technique at our institute from February 2018 to March 2020 and followed-up until September 2020. Results A total of 56 patients with fistula-in-ano were treated with the LIFT procedure during the study period, of which 20 patients had simple fistula and 36 had complex fistula. A success rate of 83% was obtained with completely healed fistulas in 46 patients. No patient developed postoperative incontinence. Conclusion Ligature of intersphincteric fistula tract is an effective treatment modality for fistula-in-ano with less procedure-related morbidity, but it is associated with a higher recurrence rate in simple fistula than in complex fistula.

show abstract

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 95%

The Ligation of the Intersphincteric Fistula Tract (LIFT) Technique for Simple and Complex Fistula-in-ano

Kumar

Arora

Ranjan

et al. 2021

Journal of Coloproctology

View full text Add to dashboard Cite

show abstract

“…This analysis included incontinence rates, which appeared to be better preserved with LIFT (incontinence rate 1.6%) than AF (7.8%) [20]. Results in non-CD patients have also suggested a benefit of improved continence with LIFT vs AF [5,13,[21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Long-term healing after complex anal fistula repair in patients with Crohn’s disease

et al. 2020

View full text Add to dashboard Cite

Background Complex anal fistula in Crohn's disease (CD) poses a challenging problem. We sought to evaluate long-term surgical healing of complex anal fistula in CD through the two robust repair options-ligation of the intersphincteric fistula tract (LIFT) and advancement flap (AF). Methods A single-center retrospective study was conducted evaluating long-term healing rates in patients with CD with complex anal fistula undergoing LIFT or AF in 2008-2018. Fistula healing was defined as closure of external wounds, cessation of drainage and absence of pain. Short-term and long-term healing rates were compared. Cox proportional hazards model was performed to identify independent predictors of fistula healing. ResultsThe study cohort included 60 CD patients undergoing LIFT (n = 38) or AF (n = 22). The AF group included 8 dermal flaps. Patients having LIFT were younger (35 years vs 43 years; p = 0.007), more likely to have a seton at the time of repair (92% vs 68%; p = 0.03) and less likely to have had prior repair attempts (34% vs 68%; p = 0.02). Short-term fistula healing occurred in 65% (n = 39) of the overall study cohort. However, at final follow-up, median 36 months (range 6-192 months), only 46% (n = 28) of repaired fistulas were healed. Considering the overall status of the cohort's perianal health at final followup, including both repaired, secondary or novel anal fistulas, only 50% (n = 30) of all patients in the cohort had all fistula sites healed and maintained bowel continuity at final follow-up. On Cox proportional hazards analysis, LIFT independently predicted long-term fistula healing (hazard ratio 2.3; 95% confidence interval 1.1-4.9; p = 0.03). Only a small number of patients (n = 5; 8%) required fecal diversion (n = 3) and/or proctectomy (n = 2). Conclusions Repair of complex anal fistula in CD results in modest healing rates. LIFT independently predicts long-term healing. However, these results must be taken in context, considering differences in patient and fistula characteristics between groups. These results ought to be kept in mind when counseling CD patients with complex anal fistula.

show abstract

“…Our results seem disappointing compared to the results in the literature, where the success rates are generally higher. Table 4 shows a review of the published studies including > 35 patients [14–25]. A systematic review in 2016 [26] evaluated articles with perineal procedures and found 19 appropriate articles with an overall success rate of 51–94%.…”

Section: Discussionmentioning

confidence: 99%

Perianal fistulas and the lift procedure: results, predictive factors for success, and long-term results with subsequent treatment

Mijnsbrugge¹,

Felt‐Bersma

et al. 2019

Tech Coloproctol

View full text Add to dashboard Cite

Background Treatment of a perianal fistula is difficult due to the risk of fecal incontinence and recurrence. The ligation of intersphincteric tract (LIFT) procedure is a sphincter-saving procedure associated with success rates ranging from 57 to 94%. The aim of our study was to find predictors for a favorable outcome of the LIFT procedure, evaluation of postoperative fecal incontinence, quality of life, and subsequent treatment with long-term follow-up. Methods This study was performed in patients who underwent LIFT between 2013 and 2015 at our institution. Their medical data were retrieved from the electronic patient files. The fistula characteristics were described by physical examination, three-dimensional endoanal ultrasound, and perioperative evaluation. Recurrence rate, postoperative fecal incontinence, and quality of life were assessed with the Patient-Reported Outcome Measurement (PROM). Thirty-two months later, long-term follow-up including subsequent procedures was evaluated. Results Forty-five patients [17 men, mean age 40 years (range 24–67 years)] were included. In 41 (84%) patients, the fistula was classified as complex; 32 (71%) were referrals with a history of previous fistula surgery. The initial success rate was 18 (40%). Only the height of the internal fistula opening (≥ 15 mm p < 0.03) was associated with recurrence. The LIFT procedure did not affect the occurrence of fecal incontinence or soiling. Recurrence showed a trend with a lower PROM ( p = 0.07). Twenty-four months later, further surgery leads to cure in 34 (75%), asymptomatic fistulas in 7 (16%), and persisting active fistulas in 4 (9%) patients. Conclusions Initial LIFT had a success rate of 40% and with subsequent surgical treatment 75%. Recurrence after LIFT is related to the height of the internal fistula opening and is associated with diminished quality of life. Continence was not affected by initial LIFT.

show abstract

Long‐term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas

Abstract: LIFT has a promising long-term outcome for HTFs, with negligible impairment on continence and improved quality of life.

Cited by 30 publications

References 32 publications

The Ligation of the Intersphincteric Fistula Tract (LIFT) Technique for Simple and Complex Fistula-in-ano

The Ligation of the Intersphincteric Fistula Tract (LIFT) Technique for Simple and Complex Fistula-in-ano

Long-term healing after complex anal fistula repair in patients with Crohn’s disease

Perianal fistulas and the lift procedure: results, predictive factors for success, and long-term results with subsequent treatment

Contact Info

Product

Resources

About