The <scp>LIFT</scp> procedure for a perianal Crohn's fistula – a video vignette

Praag, E. M. van; Buskens, C

doi:10.1111/codi.14660

Cited by 4 publications

(5 citation statements)

References 4 publications

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“…Preservation of the sphincter function is suggested to be better after LIFT for high perianal fistulas in general. 9 Our results indeed suggest that the number of patients with improved postoperative continence was higher after LIFT compared to AF. This is an important finding and is in line with the results of a recently published systematic review by Stellingwerf et al , 11 which showed higher incontinence rates after AF compared to LIFT [7.8% vs 1.6%].…”

Section: Discussionsupporting

confidence: 63%

“…LIFT procedures were performed according to previously described LIFT techniques. 9 , 14–17 After confirmation of the course of the tract, the intersphincteric plane was diathermically opened. Thereafter, the fistula tract was dissected and ligated close to the internal [and, if preferred by the surgeon, also the external] sphincter, with an absorbable suture [vicryl 2/0].…”

Section: Methodsmentioning

confidence: 99%

“…An alternative to AF is ligation of the intersphincteric fistula tract [LIFT] during which the fistula tract is ligated between the anal sphincters in the intersphincteric plane. 9 …”

Section: Introductionmentioning

confidence: 99%

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Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn’s Disease: A Retrospective Cohort Study

Praag

Stellingwerf

Bilt

et al. 2019

Journal of Crohn's and Colitis

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Abstract Background and Aims Ligation of the intersphincteric fistula tract [LIFT] and advancement flap [AF] procedures are well-established, sphincter-preserving procedures for closure of high perianal fistulas. As surgical fistula closure is not commonly offered in Crohn’s disease patients, long-term data are limited. This study aims to evaluate outcomes after LIFT and AF in Crohn’s high perianal fistulas. Methods All consecutive Crohn’s disease patients ≥18 years old treated with LIFT or AF between January 2007 and February 2018 were included. The primary outcome was clinical healing and secondary outcomes included radiological healing, recurrence, postoperative incontinence and Vaizey Incontinence Score. Results Forty procedures in 37 patients [LIFT: 19, AF: 21, 35.1% male] were included. A non-significant trend was seen towards higher clinical healing percentages after LIFT compared to AF [89.5% vs 60.0%; p = 0.065]. Overall radiological healing rates were lower for both approaches [LIFT 52.6% and AF 47.6%]. Recurrence rates were comparable: 21.1% and 19.0%, respectively. In AF a trend was seen towards higher clinical healing percentages when treated with anti-tumour necrosis factor/immunomodulators [75.0% vs 37.5%; p = 0.104]. Newly developed postoperative incontinence occurred in 15.8% after LIFT and 21.4% after AF. Interestingly, 47.4% of patients had a postoperatively improved Vaizey Score [LIFT: 52.9% and AF: 42.9%]. The mean Vaizey Score decreased from 6.8 [SD 4.8] preoperatively to 5.3 [SD 5.0] postoperatively [p = 0.067]. Conclusions Both LIFT and AF resulted in satisfactory closure rates in Crohn’s high perianal fistulas. However, a discrepancy between clinical and radiological healing rates was found. Furthermore, almost half of the patients benefitted from surgical intervention with respect to continence.

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Section: Discussionsupporting

confidence: 63%

Section: Methodsmentioning

confidence: 99%

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Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn’s Disease: A Retrospective Cohort Study

Praag

Stellingwerf

Bilt

et al. 2019

Journal of Crohn's and Colitis

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“…For example, the advancement flap procedure where a flap of (sub)mucosal tissue is pulled down over the internal fistula opening can only be performed in patients where the internal opening is not too low; otherwise, the procedure could result in a ‘wet anus’ [ 63 ]. And the LIFT procedure, where the intersphincteric plane is opened and the fistula tract ligated close to sphincter, cannot be performed in patients with a u-shaped fistula with a high mid-tract section, since this has too much risk of damaging the sphincter [ 64 ]. More research on surgical closure of perianal fistulas in Crohn’s disease patients should be initiated as most are only focussed on cryptoglandular fistulas [ 65 ].…”

Section: Perianal Crohn’s Diseasementioning

confidence: 99%

Surgical management of Crohn’s disease: a state of the art review

Praag

Buskens

Hompes

et al. 2021

Int J Colorectal Dis

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Purpose The aim of this review was to examine current surgical treatments in patients with Crohn’s disease (CD) and to discuss currently popular research questions. Methods A literature search of MEDLINE (PubMed) was conducted using the following search terms: ‘Surgery’ and ‘Crohn’. Different current surgical treatment strategies are discussed based on disease location. Results Several surgical options are possible in medically refractory or complex Crohn’s disease as a last resort therapy. Recent evidence indicated that surgery could also be a good alternative in terms of effectiveness, quality of life and costs as first-line therapy if biologicals are considered, e.g. ileocolic resection for limited disease, or as part of combination therapy with biologicals, e.g. surgery aiming at closure of select perianal fistula in combination with biologicals. The role of the mesentery in ileocolic disease and Crohn’s proctitis is an important surgical dilemma. In proctectomy, evidence is directing at removing the mesentery, and in ileocolic disease, it is still under investigation. Other surgical dilemmas are the role of the Kono-S anastomosis as a preventive measure for recurrent Crohn’s disease and the importance of (non)conventional stricturoplasties. Conclusion Surgical management of Crohn’s disease remains challenging and is dependent on disease location and severity. Indication and timing of surgery should always be discussed in a multidisciplinary team. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease rather than being a last resort therapy.

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“…So far, most reports describe results with an endorectal advancement flap (AF) [3][4][5], but the more novel technique of ligation of the intersphincteric fistula tract (LIFT) is a promising alternative sphincter-preserving procedure. The LIFT procedure, during which the fistula tract is identified and ligated in the intersphincteric plane [6], is increasingly used in clinical practice. Unfortunately, there is limited information on clinical and radiological follow-up after LIFT.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging after ligation of the intersphincteric fistula tract for high perianal fistulas in Crohn's disease: a retrospective cohort study

et al. 2020

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Aim Ligation of the intersphincteric fistula tract (LIFT) is increasingly being used for surgical closure of high perianal fistulas in Crohn’s disease. Currently, data on postoperative MRI findings are scarce, although they are considered important for assessing healing and recurrence. Our aim, therefore, was to evaluate fistula characteristics on MRI and their relationship with clinical outcomes after LIFT. Method Consecutive Crohn's patients treated with LIFT between 2007 and 2018 who underwent baseline and follow‐up MRI were retrospectively included. MRIs were scored by two radiologists according to characteristics based on the original and modified Van Assche indices. MRI findings, with emphasis on fibrosis, and the relationship with clinical healing, re‐interventions and recurrences are described. Results Twelve patients were included [four men, median age 34 (interquartile range 28–39) years]. Follow‐up MRI was performed at a median of 5.5 months (interquartile range 2.5–6.0) after LIFT. At baseline, all patients showed a tract with predominantly granulation tissue, which changed to predominantly fibrotic in seven (in three of whom it was completely fibrotic). All patients with a (predominantly) fibrotic tract had clinical closure and no re‐interventions or recurrences during long‐term follow‐up. In contrast, of the five patients with persisting granulation tissue, two reached clinical healing, two needed re‐intervention and one had a recurrence. Conclusion Markedly decreased fistula activity can be observed on MRI after LIFT. The majority of patients develop a predominantly fibrotic tract relatively soon after LIFT without clinical recurrence, suggesting a highly effective therapy. Unfavourable clinical outcomes were only present in patients with persisting granulation tissue, indicating the potential prognostic value of MRI.

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

Cited by 4 publications

References 4 publications

Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn’s Disease: A Retrospective Cohort Study

Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn’s Disease: A Retrospective Cohort Study

Surgical management of Crohn’s disease: a state of the art review

Magnetic resonance imaging after ligation of the intersphincteric fistula tract for high perianal fistulas in Crohn's disease: a retrospective cohort study

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