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

Wen, Kai; Gu, Yunfei; Sun, Xuemei; Wang, Xiaopeng; Yan, Shuai; He, Zongqi; Zhen, Shuguang

doi:10.1590/0102-672020180001e1404

Cited by 12 publications

(14 citation statements)

References 16 publications

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“…A recent study showed that removing residual fistula tissue during the LIFT procedure could improve the success rate without increasing the rate of fecal incontinence. 20 Enlightened by this research, we removed residual fistula tissue using a tunnel-based method instead of scraping the tissue. The results of the study, which has a follow-up period of 6-35 months, highlighted the effectiveness of the TROPIS procedure as it had a healing rate of 85.3%, without incontinence occurring.…”

Section: Discussionmentioning

confidence: 99%

Transanal Opening of Intersphincteric Space for Fistula-in-Ano

Chen

Wang

et al. 2021

The American Surgeon

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Background The role of the intersphincteric space in the pathogenesis of fistula-in-ano is being increasingly recognized. Submucosal and intersphincteric rectal abscesses have been surgically managed by laying open and draining the intersphincteric space as well as by the modified ligation of intersphincteric fistula tract (LIFT) procedure. In 2017, the transanal opening of intersphincteric space (TROPIS) technique was reported for the treatment of high, complex anal fistulae. Aim We aim to investigate the advantages of performing the TROPIS procedure in patients with fistula-in-ano. Methods This was a prospective cohort study investigating the outcomes in patients who had undergone a procedure using the TROPIS technique for the treatment of fistula-in-ano. Preoperative magnetic resonance imaging scans and electronic colonoscopies were performed on all patients. A clinical database evaluating the following variables was constructed: age, gender, body mass index (BMI), previous fistula surgery, type of fistula, postoperative complications, duration of follow-up, success rate, and incontinence scores pre- and postoperatively. Results The TROPIS procedure was performed on 41 patients with fistula-in-ano with a follow-up time of 6-23 months. The characteristics of the patients were as follows: 36 males, 6 females, mean age 38.6±13.2 years, and mean BMI 23.5±3.9 kg·m−2. All patients (41) had transsphincteric fistulae, and 90.2% (37) had high fistula. Of the 41 patients, 22% (9) had recurrent fistulae, 29.27% (12) had horseshoe fistulae, 7.3% (3) had supralevator fistulae, and 14.6% (6) had an associated abscess. The fistula healed completely in 85.3% (35) of patients and failed to heal in 14.7% (6) of patients, and the healing of high fistula was 86.5% (32). Of those patients who had not healed completely, 2 were found to have contracted iatrogenic infections due to foreign residues and underwent surgery with the passing of a loose seton. The additional 4 patients who had not healed underwent a fistulotomy and healed completely thereafter. There were no significant changes in incontinence scores. The incontinence scores were .15 ± .36 preoperatively and .22 ± .47 3 months postoperatively (t = −1.438, P = .16). Conclusions The TROPIS technique is a novel sphincter-preserving procedure, which can be effectively used in treating fistula-in-ano.

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Section: Discussionmentioning

confidence: 99%

Transanal Opening of Intersphincteric Space for Fistula-in-Ano

Chen

Wang

et al. 2021

The American Surgeon

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“…Wen et al similarly found, patients that failed or had a recurrence, their fistula was able to be downgraded and successfully treated. 14 Again, a 2019 danish publication evaluating LIFT for high transphincteric fistula found a relatively low primary healing rate but demonstrating good overall results. 15 Sixty-five patients with high transphincteric fistula underwent LIFT with a primary healing rate of 42%.…”

Section: Liftmentioning

confidence: 99%

High perianal fistula: a narrative review of common management techniques

Micallef

Barns²

2022

Int Surg J

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Perianal fistula is a common and problematic condition that results in perianal pain, recurrent infection, anal discharge and overall reduced quality of life. Low perianal fistula, those that involve the lower third of the external anal sphincter, are relatively easily managed with the use of a fistulotomy. However, high perianal fistula, ones that involve the upper two thirds of the external anal sphincter are extremely difficult to treat. There is no consensus on best management of these type of fistula with little high-quality evidence to guide management. We perform a narrative review of recent literature on common surgical techniques and provide an opinion of the utility of each to guide management.

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“…Fistulotomy, after an interval of an indwelling seton to mature and fibrose the tract, has been the traditional preferred management for transsphincteric fistulas (TSFs) [1,2]. Despite low recurrence rates, fistulotomy for TSF has been associated with faecal incontinence and potential litigation [3,4]. Ligation of the intersphincteric fistula tract (LIFT) has been widely adopted as an alternative surgical option.…”

Section: Introductionmentioning

confidence: 99%

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?

et al. 2020

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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.

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

Cited by 12 publications

References 16 publications

Transanal Opening of Intersphincteric Space for Fistula-in-Ano

Transanal Opening of Intersphincteric Space for Fistula-in-Ano

High perianal fistula: a narrative review of common management techniques

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?

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