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

Abstract

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.

Simple fistula-in-ano: is it all simple? A systematic review

“…Finally, 94 full text articles were assessed for eligibility; however, 28 of them were excluded, mainly because of the impossibility of isolating data on patients affected by simple AFs from mixed case reports. Therefore, a total of 66 articles [ 2 , 8 , 13 – 76 ] were found to be eligible (Fig. 1 ).…”

“…The publication dates of the articles range from 1994 to 2020. Among the included studies, 28 were prospective studies [ 21 – 25 , 29 , 38 – 40 , 42 , 44 , 48 , 51 , 53 , 56 , 58 – 62 , 64 , 65 , 68 , 70 , 71 , 74 – 76 ], 19 were retrospective series [ 2 , 8 , 13 – 15 , 18 , 26 – 28 , 33 , 43 , 45 , 57 , 63 , 66 , 67 , 69 , 72 , 73 ], and 19 were randomized clinical trials (RCT) [ 16 , 17 , 19 , 20 , 30 – 32 , 34 – 37 , 41 , 46 , 47 , 49 , 50 , 52 , 54 , 55 ] (Tables 1 – 2 ). The quality of the studies was generally low with a consistent risk of bias; the median score of the Jadad Scale for RCT was 3 (1–5), and only 2 studies had the highest possible score [ 52 , 55 ]; the median MINORS score for non-comparative studies was 12 (3–16), with only one study that could be regarded as excellent [ 44 ], while the median MINORS score for comparative studies was 17 (8–21) (Tables 1 , 2 ).…”

“…Among those, glues/pastes (fibrin glue, Permacol® collagen paste, and cyanoacrylate glue) were the most frequently analyzed procedures with ten records [ 20 , 28 , 58 , 60 , 61 , 64 , 65 , 68 , 71 , 74 ]. LIFT and the laser closure of fistula tracts were reported in five [ 54 , 62 , 66 , 69 , 76 ] and four studies [ 59 , 67 , 70 , 72 ], respectively. Other procedures adopted are detailed in Table 2 .…”

“…Seven studies [ 2 , 38 , 41 , 44 , 51 , 71 , 76 ] evaluated the effects of surgery on patients’ QoL and satisfaction, even if the data for simple AFs could not be extrapolated for two of them [ 51 , 71 ]. The postoperative onset of fecal incontinence reduced patients’ QoL in a retrospective series [ 2 ], while it had no significant effect in another prospective study [ 44 ]; the recurrence of the disease had a negative impact on QoL in a recent prospective study [ 76 ]; finally, two reports [ 38 , 41 ] stated that patient satisfaction after surgery for a simple AF was high or very high in 86.4% and 90.6% of patients, respectively.…”

The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

“…1). 6,10,11,[14][15][16][17][18][19][20] The median age of the included patients was 44 years, and the female/male ratio was 23%/77%.…”