Long-term Results of Ligation of Intersphincteric Fistula Tract (LIFT) for Fistula-in-Ano

Abstract

Our study demonstrates favorable long-term results for the ligation of intersphincteric fistula tract procedure. It appears that long tracts negatively affect healing, and late failures can occur up to 12 months postoperatively. Understanding the type of failure can help guide subsequent treatment to maximize healing success.

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

“…The failure rate is approximately 30-60 % for established surgical procedures such as the endorectal advancement flap (ERAF) [3,4] and injection of biological glues [5,6]. Also the initial enthusiasm for even newer techniques, such as anal fistula plug [7,8] and ligation of the intersphincteric fistula tract (LIFT) [9,10], decreased at the long-term follow-up, with a recurrence rate of about 70-80 % and 30-60 %, respectively [11][12][13][14][15].…”

The LIFT procedure

“…9 Other consistent risk factors across several studies include obesity and smoking. 12,16,21 The contribution of a prior history of surgery has been less clear. Liu et al and Abcarian et al found it to be a significant risk factor.…”

“…Thus, many advocate for the routine use of a draining seton for 2-3 months so as to allow for effective drainage and resolution of sepsis, as well as allowing fibrosis to occur and mature along the tract, allowing for easier identification and suture ligation of the intersphincteric fistula tract. 17 While this seems a logical step, interestingly, the usefulness of interval seton drainage prior to LIFT has not been borne out in multivariate 4,16,18,19 or meta-analyses. 13 We have indeed found the converse to be true.…”

“…We saw a recurrence rate of 6.5% (6/ 93) with the median time between treatment and recurrence of 22 weeks (range: 15-32 weeks). 9 In another study, published by Liu et al, 16 failures were classified as early (80%) or late (20%). Early failures were usually due to technical or procedural issues.…”

Operative Verfahren bei hohen kryptoglandulären Analfisteln: Systematische Übersicht und Metaanalyse

“…6). Doch eine in jüngster Zeit durchgeführte Studie, in der erstmals MAF mit LIFT verglichen wurde, fand mit einer Verschlussrate von nur 60 % für beide Verfahren ein ähnliches Ergebnis [13]. In zwei Studien wurde prä-und postoperativ der Kontinenzstatus mithilfe der Vaizey-Skala objektiviert [20,21].…”