Effectiveness of ligation of intersphincteric fistula tract (LIFT) in the management of fistulas in ano

Background: Fistula in ano is an abnormal connection between the epithelized surface of anal canal and usually the perianal skin. It is a benign treatable lesion of rectum and anal canal. Crypto glandular infection accounts for about ninety percent of the cases. The estimated prevalence of an anal fistula is 12 to 28/1000000 of the population per year with male to female ratio 1.8:1. Ligation of intersphincteric fistula tract is a new sphincter saving method with good result in the management of anal fistula. The aim of study was to evaluate the effectiveness and functional outcomes of the ligation of intersphinteric fistula tract (LIFT).Methods: This prospective study includes sixteen patients who were operated for fistulas in ano at Bundelkhand Medical College and Associated Hospital, Sagar from January 2015 to June 2017. Patients above the age of 20 years, proved cases of fistulas in ano without co-morbid conditions and no previous surgical intervention were included in the study. Patients presenting with fistulas from another source such as crohn’s disease, tuberculosis, anal cancer and recurrent fistulas were excluded. A detailed history, clinical presentation, digital rectal examination, anal ultrasound and routine investigations were done in all cases.Results: In the present study most of the patients were male and presents with perianal discharge. The diagnosis is made by clinical history, per rectal examination and anal ultrasonography. All the sixteen patients with fistula in ano underwent ligation of intersphincteric fistula tract (LIFT). The patients were followed for a period of three months. Most of the cases (87.5%) healed within 4-6 weeks. The recurrence of fistula occurs in four cases (25%). Recurrence is due to infection and technical error in the procedures. There were no deaths in the study.Conclusions: The LIFT technique proved to be safe and effective in the treatment of fistula in ano.

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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

Journal of Coloproctology ◽

10.1055/s-0041-1730039 ◽

2021 ◽

Author(s):

Carlos Placer-Galán ◽

Jose Mª Enriquez-Navascués ◽

Tania Pastor-Bonel ◽

Ignacio Aguirre-Allende ◽

Yolanda Saralegui-Ansorena

Keyword(s):

Systematic Review ◽

Anal Fistula ◽

Meta Analysis ◽

Fistula Tract ◽

Cochrane Library ◽

Fistula In Ano ◽

Intersphincteric Fistula ◽

The Impact ◽

Seton Placement ◽

Primary Healing

Abstract Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design systematic review and meta-analysis. Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%) Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

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Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano

Colorectal Disease ◽

10.1111/codi.12062 ◽

2013 ◽

Vol 15 (5) ◽

pp. 582-586 ◽

Cited By ~ 36

Author(s):

J. G. Han ◽

B. Q. Yi ◽

Z. J. Wang ◽

Y. Zheng ◽

J. J. Cui ◽

...

Keyword(s):

Anal Fistula ◽

New Technique ◽

Fistula Tract ◽

Fistula In Ano ◽

Fistula Plug ◽

Anal Fistula Plug ◽

Intersphincteric Fistula ◽

A New Technique

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Comparative Study between Open Fistulectomy and Ligation of Intersphincteric Fistulas Tract (LIFT) Procedure for Uncomplicated Perianal Fistula

Volume 5 - 2020, Issue 9 - September - International Journal of Innovative Science and Research Technology ◽

10.38124/ijisrt20aug348 ◽

2020 ◽

Vol 5 (8) ◽

pp. 753-759

Author(s):

Dr. Mir Rasekh Alam Ovi ◽

Dr. Shamima Nasrin ◽

Dr. Md. Musab Khalil ◽

Dr. Farhan Imtiaz Chowdhury

Keyword(s):

Wound Healing ◽

Perianal Fistula ◽

Medical College Hospital ◽

Fistula Tract ◽

Main Concept ◽

College Hospital ◽

Female Ratio ◽

Fistula In Ano ◽

Medical College ◽

Intersphincteric Fistula

A new sphincter-saving procedure involving the ligation of the intersphincteric fistula tract (LIFT) procedure was recently described by Rojanasakul et al from Thailand. The main concept in the LIFT is to identify the fistula tract in the intersphincteric space and the subsequent ligation and division of the tract. Some studies abroad have shown a considerably high success rate in terms of wound healing and absence of incontinence in treating fistula-in-ano by this procedure. This study aimed to compare between the earlier fistulectomy and this new innovative LIFT technique. The study was designed as a comparative type of observational study conducted at Dhaka Medical College Hospital, Dhaka and Popular Medical College Hospital from January 2014 to December 2014. Study was carried out on 40 hospital admitted patients with uncomplicated Fistula-in-ano, irrespective of age and sex. LIFT and fistulectomy was the procedure as operative treatment for their disease. Outpatient follow-up was undertaken. In our study, 30 (75%) male and 10 (25%) female patients were operated with a male to female ratio 3: 1. Mean age was 37.3 years. Vast majority of the cases i.e 23 fistula (68%) was inter-sphincteric type and the rest 17 (32%) were trans-sphincteric type. Fistulectomy took less time than LIFT. Spinal Headache was the most common complication 7.5% (3 cases). No difference was found in comparison to wound healing. (p =00.18). LIFT was found better than fistulectomy regarding post-operative incontinence (p =0.008). LIFT was found better in term of recurrence (p = 0.04) than fistulectomy but in long term there is no difference (p=0.3). In treatment of uncomplicated perianal fistula LIFT has no benefit over fistulectomy

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Lift procedure for long complex ano-scrotal fistula and review of literature

International Surgery Journal ◽

10.18203/2349-2902.isj20164484 ◽

2016 ◽

Vol 4 (1) ◽

pp. 423

Author(s):

T. Siva Kumar ◽

G. Naresh ◽

Md. Jawed Akther

Keyword(s):

Surgical Management ◽

Anal Fistula ◽

Acute Phase ◽

Abscess Formation ◽

Fistula Tract ◽

Anal Continence ◽

Review Of Literature ◽

Fistula In Ano ◽

Intersphincteric Fistula ◽

Purulent Drainage

Ano-rectal sepsis can be complicated by anal fistula during the acute phase of sepsis or within 6 months thereafter. An anal fistula is characterised by chronic purulent drainage or cyclical pain associated with abscess formation, followed by intermittent spontaneous decompression. A fistula-in-ano can be "simple" or "complex". The goal of surgical management is to effectively eradicate current and recurrent septic foci, associated epithelialized tracts and preserve continence. Study present a case of 22 year old male with long recurrent complex ano-scrotal fistula which was treated by ligation of the intersphincteric fistula tract (LIFT) procedure, preserving the anal continence without leaving any residual septic foci that may lead to recurrence.

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Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

International Surgery Journal ◽

10.18203/2349-2902.isj20200811 ◽

2020 ◽

Vol 7 (3) ◽

pp. 721

Author(s):

Davinder Koli ◽

Pravin Kumar ◽

Viraj Panda ◽

Manu Vats

Keyword(s):

Anal Fistula ◽

Fistulous Tract ◽

Significant Risk ◽

Digital Rectal Examination ◽

Fistula Tract ◽

Internal Opening ◽

Cyanoacrylate Glue ◽

Fistula In Ano ◽

Infant Feeding Tube

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

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Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000200004 ◽

2014 ◽

Vol 27 (2) ◽

pp. 101-103 ◽

Cited By ~ 8

Author(s):

Sergio Danilo Tanahara TOMIYOSHI ◽

Carlos Henrique Marques DOS SANTOS

Keyword(s):

Fecal Incontinence ◽

Anal Fistula ◽

Anorectal Manometry ◽

Fistulous Tract ◽

Complete Healing ◽

Fistula Tract ◽

Anal Fistulas ◽

Intersphincteric Fistula ◽

The Mean ◽

Initial Results

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence.

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

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1404 ◽

2018 ◽

Vol 31 (4) ◽

Cited By ~ 4

Author(s):

Ke WEN ◽

Yun-Fei GU ◽

Xue-Liang SUN ◽

Xiao-Peng WANG ◽

Shuai YAN ◽

...

Keyword(s):

Success Rate ◽

Operative Procedure ◽

Cleveland Clinic ◽

Fistula Tract ◽

Long Term Outcomes ◽

Fistula In Ano ◽

Complex Fistula ◽

Intersphincteric Fistula

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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