LONG-TERM OUTCOMES OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT FOR COMPLEX FISTULA-IN-ANO: MODIFIED OPERATIVE PROCEDURE EXPERIENCE

ABSTRACT Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.

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

Diseases of the Colon & Rectum ◽

10.1097/dcr.0b013e318278164c ◽

2013 ◽

Vol 56 (3) ◽

pp. 343-347 ◽

Cited By ~ 60

Author(s):

Wendy Y. Liu ◽

Armen Aboulian ◽

Amy H. Kaji ◽

Ravin R. Kumar

Keyword(s):

Long Term Results ◽

Fistula Tract ◽

Fistula In Ano ◽

Intersphincteric Fistula

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Long-term Outcomes of Laser Ablation of Fistula Tract for Fistula-in-Ano

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000001628 ◽

2020 ◽

Vol 63 (6) ◽

pp. 831-836

Author(s):

Ozgen Isik ◽

Baris Gulcu ◽

Ersin Ozturk

Keyword(s):

Laser Ablation ◽

Fistula Tract ◽

Long Term Outcomes ◽

Fistula In Ano

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LIFT and BioLIFT: a 10-Year Single-Centre Experience of Treating Complex Fistula-In-Ano With Ligation of Intersphincteric Fistula Tract Procedure With or Without Bio-prosthetic Reinforcement (BioLIFT)

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-019-04305-x ◽

2019 ◽

Vol 24 (3) ◽

pp. 671-676 ◽

Cited By ~ 2

Author(s):

Yee Chen Lau ◽

Kilian G. M. Brown ◽

Juyong Cheong ◽

Christopher Byrne ◽

Peter J. Lee

Keyword(s):

Fistula Tract ◽

Single Centre ◽

Fistula In Ano ◽

Single Centre Experience ◽

Complex Fistula ◽

Intersphincteric Fistula ◽

Prosthetic Reinforcement

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Long-term outcomes of (Gore) fistula plug versus ligation of intersphincteric fistula tract for anal fistula

Journal of Coloproctology ◽

10.1016/j.jcol.2018.07.003 ◽

2018 ◽

Vol 38 (4) ◽

pp. 314-319

Author(s):

Abdullah Alhaddad ◽

Ali Mouzannar ◽

Aqeel Ashraf ◽

Bader Marafi ◽

Ibtisam Albader ◽

...

Keyword(s):

Anal Fistula ◽

Fistula Tract ◽

Long Term Outcomes ◽

Fistula Plug ◽

Intersphincteric Fistula

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Efficacy of Lift (Ligation of Intersphincteric Fistula Tract) for Complex and Recurrent Anal Fistulas - A Single-Center Experience and A Review of the Literature

Polish Journal of Surgery ◽

10.2478/pjs-2014-0094 ◽

2015 ◽

Vol 86 (11) ◽

Cited By ~ 3

Author(s):

Michał Romaniszyn ◽

Piotr Julian Walega ◽

Wojciech Nowak

Keyword(s):

Success Rate ◽

Current Literature ◽

Operating Time ◽

Late Complications ◽

Fistula Tract ◽

Single Center ◽

Anal Fistulas ◽

Single Center Experience ◽

Intersphincteric Fistula

AbstractLigation of intersphincteric fistula tract in treatment of anal fistulas (LIFT) is being said to have satisfactory results in short and long follow up, with low risk of complications. This study was designed to evaluate the results in patients with complex and recurrent fistulas in comparison with simple transsphincteric anal fistulas.was to present a single-center experience in LIFT procedure in treatment of both simple and complex anal fistulas, including recurrent fistulas, in comparison with a review of current literature.A series of 17 patients were qualified to LIFT procedure. 5 patients were treated for simple transsphincteric, 6 for complex fistulas, 6 with fistulas recurrent after fistulotomy. Median age was 47, most of the patients were male (16/17). Mean follow up was 11 months.Mean operating time was 55 minutes counting from surgical site disinfection to final dressing of the wound. Of the 17 patients the overall success rate was 53%. As expected, best results were achieved in patients with simple fistulas (80% success rate), then complex (50%), and recurrent fistulas (only 33%). There were no early nor late complications of the surgery.As expected, in simple transsphincteric fistulas the results were satisfactory, taking into account low complication rate. Complex and recurrent fistulas seem to be risk factors of LIFT failure. The results are consistent with data published by other authors, based on the review of the current literature, and it seems there is still room for improvement, so further research is required.

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INTERESFINCTERIAL LIGATION OF FISTULA TRACT (LIFT) FOR PATIENTS WITH ANAL FISTULAS: A BRAZILIAN BI-INSTITUTIONAL EXPERIENCE

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700040002 ◽

2017 ◽

Vol 30 (4) ◽

pp. 235-238 ◽

Cited By ~ 2

Author(s):

Sérgio Eduardo Alonso ARAÚJO ◽

Marcelli Tainah MARCANTE ◽

Carlos Ramon Siveira MENDES ◽

Alexandre Bruno BERTONCINI ◽

Victor Edmond SEID ◽

...

Keyword(s):

Success Rate ◽

Operative Time ◽

Fistula Tract ◽

Anal Fistulas ◽

Modified Technique ◽

External Orifice ◽

Institutional Experience ◽

Observational Cohort ◽

Intersphincteric Fistula

ABSTRACT Background : The best treatment for anal fistula should extirpate infection and promote healing of the tract, whilst preserving the anal sphincter complex and full continence. Aim: To analyze the success rate after a modified technique for ligation of the intersphincteric fistula tract (LIFT) for patients with anal fistulas. Methods: A prospective (observational cohort study) Brazilian bi-institutional experience with a modified (ligation of the intersphincteric fistula tract without excision) LIFT technique was undertaken. A clinical database was settled for the following variables: age, gender, BMI, comorbidities, distance between external orifice and the anus, previous fistula surgery, type of fistula, operative time, intra- and postoperative complications, duration of follow-up, and success rate. Results: Between November 2015 and January 2017, 38 patients with transsphincteric fistulas were operated on using the modified LIFT procedure. Seventeen (44.7%) were men. Median age was 41 (18-67) years. Median BMI was 26.4 (22-38) kg/m2. Five (13.2%) had undergone previous surgery. The fistula was transsphincteric in all cases. Median follow-up was 32 (range, 14-56) weeks. Success was observed in 30 (79%) patients. Conclusions: The LIFT technique without excision of the fistula tract proved to be safe and effective for transsphincteric anal fistulas.

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Transanal Opening of Intersphincteric Space for Fistula-in-Ano

The American Surgeon ◽

10.1177/0003134821989048 ◽

2021 ◽

pp. 000313482198904

Author(s):

Yu-bo Li ◽

Ju-hua Chen ◽

Meng-di Wang ◽

Jun Fu ◽

Bing-chuan Zhou ◽

...

Keyword(s):

Fistula Tract ◽

Resonance Imaging ◽

Clinical Database ◽

Fistula In Ano ◽

Fistula Surgery ◽

P 16 ◽

Preoperative Magnetic Resonance ◽

Intersphincteric Fistula

Background The role of the intersphincteric space in the pathogenesis of fistula-in-ano is being increasingly recognized. Submucosal and intersphincteric rectal abscesses have been surgically managed by laying open and draining the intersphincteric space as well as by the modified ligation of intersphincteric fistula tract (LIFT) procedure. In 2017, the transanal opening of intersphincteric space (TROPIS) technique was reported for the treatment of high, complex anal fistulae. Aim We aim to investigate the advantages of performing the TROPIS procedure in patients with fistula-in-ano. Methods This was a prospective cohort study investigating the outcomes in patients who had undergone a procedure using the TROPIS technique for the treatment of fistula-in-ano. Preoperative magnetic resonance imaging scans and electronic colonoscopies were performed on all patients. A clinical database evaluating the following variables was constructed: age, gender, body mass index (BMI), previous fistula surgery, type of fistula, postoperative complications, duration of follow-up, success rate, and incontinence scores pre- and postoperatively. Results The TROPIS procedure was performed on 41 patients with fistula-in-ano with a follow-up time of 6-23 months. The characteristics of the patients were as follows: 36 males, 6 females, mean age 38.6±13.2 years, and mean BMI 23.5±3.9 kg·m−2. All patients (41) had transsphincteric fistulae, and 90.2% (37) had high fistula. Of the 41 patients, 22% (9) had recurrent fistulae, 29.27% (12) had horseshoe fistulae, 7.3% (3) had supralevator fistulae, and 14.6% (6) had an associated abscess. The fistula healed completely in 85.3% (35) of patients and failed to heal in 14.7% (6) of patients, and the healing of high fistula was 86.5% (32). Of those patients who had not healed completely, 2 were found to have contracted iatrogenic infections due to foreign residues and underwent surgery with the passing of a loose seton. The additional 4 patients who had not healed underwent a fistulotomy and healed completely thereafter. There were no significant changes in incontinence scores. The incontinence scores were .15 ± .36 preoperatively and .22 ± .47 3 months postoperatively (t = −1.438, P = .16). Conclusions The TROPIS technique is a novel sphincter-preserving procedure, which can be effectively used in treating fistula-in-ano.

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Management of Complex Fistula in Ana with Fistulotomy and Stage Procedure

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i1.38952 ◽

2018 ◽

Vol 27 (1) ◽

pp. 83-87

Author(s):

MNH Masum ◽

A Yazdani ◽

M Masum ◽

MS Biswas ◽

MA Bhuiyan ◽

...

Keyword(s):

Anal Verge ◽

Advancement Flap ◽

Single Stage ◽

Fistula Tract ◽

Internal Opening ◽

Fistula In Ano ◽

Medical College ◽

Stool Incontinence ◽

Complex Fistula

Background: Complex fistula in ano is a troublesome disease and is difficult to treat. Complex fistula in ano occurs in various forms like multiple external and/or internal openings, internal opening above the dentate line, external opening far away from anal verge, anterior tract etc. They are almost invariably recurrent and frequently associated with other systemic diseases like tuberculosis, inflammatory bowel disease, malignancy etc.A complex fistula in ano has various modalities of treatments like application of setons, fistulotomy or fistulectomy, endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser and ligation of intersphincteric fistula tract (LIFT). Objective: The purpose of the study is to evaluate the outcome of complex fistula in ano by fistulotomy and staged procedure. Methods: The study was held in Dhaka medical college Hospital and various private hospitals located in Dhaka and Brahmonbaria within duration of 8 years (from January, 2011 to January, 2018). Among 256 patients (221 male, 35 female) with median age 48 years (30 to 72 years) with the diagnosis of complex fistula in ano, 135 underwent fistulotomy with application of Seton with stage procedure. 121 patients underwent single stage fistulotomy. 158 patients had history of previous operations. After stage procedure, regular follow up was done every week until wound healing occurred. Result: Among 256 patients 121 patients (47%) underwent single stage, 133 (52%) patients underwent two stage and 2 patients underwent three stage procedure during the trial period. Majority of the patients had minor incontinence; that is flatus and/or loose stool incontinence. But they only persisted for an average of 10 to 16 days and subsided spontaneously. None of the patient had any major (solid stool) incontinence. 4 patients (2%) had recurrence of fistula on an average of 3-6 months after complete healing. Recurrence occurred in the form of abscess, automatically burst internally, recurrent fistula.2 patients developed bleeding after single stage procedure and was managed by cauterization. Conclusion: With adequate postoperative care and regular follow up, application of Seton with ‘staged procedure’ in cases of complex fistula in ano is very effective and has very minimal complications. Chance of major incontinence and recurrence is also less. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 83-87

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