Systematic review and meta‐analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

Abstract

Background High perianal fistulas require sphincter‐preserving surgery because of the risk of faecal incontinence. The ligation of the intersphincteric fistula tract (LIFT) procedure preserves anal sphincter function and is an alternative to the endorectal advancement flap (AF). The aim of this study was to evaluate outcomes of these procedures in patients with cryptoglandular and Crohn's perianal fistulas. Methods A systematic literature search was performed using MEDLINE, Embase and the Cochrane Library. All RCTs, cohort studies and case series (more than 5 patients) describing one or both techniques were included. Main outcomes were overall success rate, recurrence and incontinence following either technique. A proportional meta‐analysis was performed using a random‐effects model. Results Some 30 studies comprising 1295 patients were included (AF, 797; LIFT, 498). For cryptoglandular fistula (1098 patients), there was no significant difference between AF and LIFT for weighted overall success (74·6 (95 per cent c.i. 65·6 to 83·7) versus 69·1 (53·9 to 84·3) per cent respectively) and recurrence (25·6 (4·7 to 46·4) versus 21·9 (14·8 to 29·0) per cent) rates. For Crohn's perianal fistula (64 patients), no significant differences were observed between AF and LIFT for overall success rate (61 (45 to 76) versus 53 per cent respectively), but data on recurrence were limited. Incontinence rates were significantly higher after AF compared with LIFT (7·8 (3·3 to 12·4) versus 1·6 (0·4 to 2·8) per cent). Conclusion Overall success and recurrence rates were not significantly different between the AF and LIFT procedure, but continence was better preserved after LIFT.

The LIFT procedure for a perianal Crohn's fistula – a video vignette

“…The LIFT procedure was first described in 2007 [1] and is increasingly being used. Studies suggest that it has comparable success rates to the more commonly used advancement flap [2]. Even in patients with Crohn's fistulas, promising results concerning clinical and radiological healing as well as low rates of incontinence have been reported [3].…”

“…However, the Sugarbaker and keyhole mesh configurations appear to be the most common [1]. In a cadaveric model, Pauli et al [2] described a novel method of open PH repair utilizing retromuscular dissection, posterior component separation via transversus abdominis release (TAR) and lateralization of the bowel utilizing a modified Sugarbaker mesh configuration within the retromuscular space. Belyansky et al [3] applied a robotic technique for PH in an effort to reduce wound morbidity and length of hospitalization, while still providing a secure and durable repair.…”

A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes

“…Surgical procedures developed to treat complex stulas include ligation of the stula tract (LIFT), 9 videoassisted anal stula treatment (VAAFT), 10,11 and endorectal advancement ap (EAF). 12,13 Non-surgical options include brin glue plugs and stem cell paste.…”

Ligadura interesfintérica de trayecto fistuloso como tratamiento de fístula anorrectal compleja

“…[13][14][15][16][17] Algunos autores consideran que se debe colocar un setón de drenaje ocho semanas previas a la realización de un LIFT, ya que consideran que esta medida elimina el foco séptico y promueve la fibrosis del trayecto fistuloso, facilitando posteriormente la disección del espacio interesfintérico y la ligadura del trayecto. [18][19][20][21][22][23][24][25] El objetivo de este trabajo es describir la experiencia con técnica de LIFT en fístulas anales transesfintéricas altas (complejas) de un mismo grupo quirúrgico, y describir las modificaciones que hemos realizado a esta técnica.…”