Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT)

Abstract

Anal fistula management has long been a challenge for surgeons. Presently, no technique exists that is ideal for treating all types of anal fistula, whether simple or complex. A higher incidence of poor sphincter function and recurrence after surgery has encouraged the development of a new sphincter-sparing procedure, ligation of the intersphincteric fistula tract (LIFT), first described by Van der Hagen et al. in 2006. We assessed the safety, feasibility, success rate, and continence of LIFT as a sphincter-saving procedure. A literature search of articles in electronic databases published from January 2006 to August 2012 was performed. Analysis followed Preferred Reporting Items for Systematic Reviews recommendations. All LIFT-related articles published in the English language were included. We excluded case reports, abstracts, letters, non-English language articles, and comments. The procedure was described in detail as reported by Rojanasakul. Thirteen original studies, including 435 patients, were reviewed. The most common fistula procedure type was transsphincteric (92.64 %). The overall median operative time was 39 (±20.16) min. Eight authors performed LIFT as a same-day surgery, whereas the others admitted patients to the hospital, with an overall median stay of 1.25 days (range 1-5 days). Postoperative complications occurred in 1.88 % of patients. All patients remained continent postoperatively. The overall mean length of follow-up was 33.92 (±17.0) weeks. The overall mean healing rate was 81.37 (±16.35) % with an overall mean healing period of 8.15 (±5.96) weeks. Fistula recurrence occurred in 7.58 % of patients. LIFT represents a new, easy-to-learn, and inexpensive sphincter-sparing procedure that provides reasonable results. LIFT is safe and feasible, with favorable short- and long-term outcomes. However, additional prospective randomized studies are required to confirm these findings.

MR Imaging of Perianal Crohn Disease

“…The internal opening may be closed and the distal portion of the tract is curetted but remains open to facilitate drainage. Promising but varied rates of healing between 57% and 94% have been reported, but there is very limited data dedicated to CD patients (5,78,(90)(91)(92)(93).…”

S3 guidelines: cryptoglandular anal fistulas

“…In einer vergleichenden Studie zwischen LIFT und Mukosa-Flap bei hohen Analfisteln erzielten Tan et al [420] Trotz der kurzen Zeit, in der die relevanten Arbeiten erschienen, wurde das LIFT-Verfahren bereits in mehreren Reviews untersucht: Vergara-Fernandez (18 Studien) [465], Alasari (13 Studien) [18], Yassin (13 Studien) [487], Sirany (26 Studien) [398]und Hong (24Studien) [186]. Die aktuellste Arbeit von Sirany et al [398] [6,16,380,503].…”

Tumours and inflammatory lesions of the anal canal and perianal skin revisited: an update and practical approach

“…The acute phase will present as an abscess, whereas fistula tracts tend to form in more chronic stages 82. For management purposes, anal fistulas can be classified as simple or complex and divided into five types based on the involvement of the anal sphincter muscles: submucosal/superficial, intersphincteric, transsphincteric, suprasphincteric and extrasphincteric 83. The surgical technique will vary according to anatomical presentation and is usually curative for patients with idiopathic fistulas.…”