Ligation of the Intersphincteric Fistula Tract (LIFT) Technique in the Treatment of Complex Perianal Fistula: Experience of First 50 Cases

Perianal fistula is a common disease and surgery is the only treatment option. Many surgical techniques have been described. Ligation of intersphincteric fistula tract (LIFT) is a sphincter saving surgical technique in which fistula tract is ligated and excised through intersphincteric approach. The aim of study is to present our experience of first 50 LIFT procedures particularly healing rate, recurrence rate and complications from the procedure. This is a prospective observational study started from March 2018 on whom underwent LIFT procedure for primary complex perianal fistula of infective origin at Faridpur Central Hospital and Faridpur Medical College Hospital. In this study, 50 patients (42 male and 8 female) of average age of 39±7.6 years with complex fistula were included. The mean operative time was 34.7±5.67 minutes and most of the fistulas were transsphincteric variety (90%). Median wound healing time was 21.45±6.34 days for intersphincteric wound and 26.78±6.93 days for the external opening of the fistula. Mean follow up period was 10.5 months. Seven patients of our series developed recurrent fistula, making the overall success of 86%. None of the patient in our series developed incontinence. LIFT procedure has the advantage of preservation of anal sphincter, minimal tissue injury, shorter healing time, relatively easy to perform, and high success rate. It's a good choice for treatment of complex perianal fistula. Faridpur Med. Coll. J. Jan 2020;15(1): 3-7

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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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LIGATION OF INTERSPHINCTERIC FISTULA TRACT AS AN ALTERNATIVE TREATMENT FOR PERIANAL FISTULA AT TERTIARY CARE HOSPITAL

LIAQUAT MEDICAL RESEARCH JOURNAL ◽

10.38106/lmrj.2021.3.3-02 ◽

2021 ◽

Vol 3 (3) ◽

pp. 53-58

Author(s):

Nawaz Ali Dal ◽

Ishrat Raheem Katyar ◽

Mohammad Qasim Mallah ◽

Ahsan Laghari ◽

Shiraz Shaikh ◽

...

Keyword(s):

Fistulous Tract ◽

Tertiary Care ◽

Perianal Fistula ◽

Perianal Abscess ◽

Sampling Technique ◽

Fistula Tract ◽

Care Hospital ◽

Therapeutic Success ◽

Preoperative Symptom ◽

Intersphincteric Fistula

This study was aimed to evaluate clinical outcome of patients with perianal fistula operated with the ligation of intersphincteric fistula tract (LIFT) technique. The study was conducted at Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro from July 2018 and August 2019. A total of 22 patients diagnosed with perianal fistula operated with the Ligation of Intersphincteric Fistula Tract (LIFT) technique were selected using non-probability consecutive sampling technique. Physical examination and magnetic resonance imaging (MRI) and/or endosonography (ES) were performed to make a confirmed diagnosis of fistula. They were classified according to Parks classification. All patients were subjected to intersphincteric fistulous tract ligation using the technique defined by Rojanasakul modified. There were 16 males and 6 females. Mean age was 42 years (range 23-68 years of age). Out of 22 patients, 17 patients had a history of perianal abscess drainage prior to surgery and an average preoperative symptom presentation was 2.2 years (range 0-10 years). Therapeutic success with first surgery was achieved in 77% and with a second surgery in 90%. None of this patients modified their preoperative Wexner. It was concluded that LIFT technique appears to be a convenient, reproducible, and effective surgical alternative. This provides an appropriate closing rate and without continence modification, Therefore indicated for complex cryptoglandular fistulas.

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CLINICAL CHARACTERISTICS, CLASSIFICATION AND RESULTS OF TREATMENT RECURRENT ANAL FISTULA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.2.8 ◽

2019 ◽

Author(s):

Toulabouth Manothay ◽

Doan Van Phu Nguyen

Keyword(s):

Wound Healing ◽

Surgical Treatment ◽

Anal Fistula ◽

Postoperative Hemorrhage ◽

Healing Time ◽

University Hospital ◽

Fistula Tract ◽

Cross Sectional ◽

Recurrent Fistula ◽

Results Of Treatment

Objectives: To evaluate the results of surgical treatment of recurrent anal fistula. Methods: This was a cross-sectional, descriptive study including 30 recurrent anal fistula patients who underwent surgery from March 2017 to August 2018 at Hue University Hospital of Medicine and Pharmacy and Hue Central Hospital. Results: Male/female radio was 4/1. The highest proportion was among the ages of 21 – 60 (90%). The most common clinical presentation was perianal discharge in 86.7% of cases. The average duration of disease was found to be 2.5 ± 1.7 months approximately. Early postoperative complications rate is. 36.7% including: air or facial incontinence (33.4%),,postoperative hemorrhage (3.s3%). Average wound healing time is 7.5 ± 2.3 weeks and delayed wound healing rate is 100%. Results of surgical treatment of recurrent fistula anal are good 90%, mid 6.7%, poor 3.3%. Conclusions: Surgical treatment of recurrent anal fistula must depend upon the understanding the relative between anal sphincter and fistula tract. Surgical procedures have to be suitable for each type of anal fistulas. Key words: anal fistula, recurrent, surgical treatment

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A PROSPECTIVE STUDY ON EFFECTIVENESS OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) IN ANAL FISTULAS

10.36106/ijsr/4228234 ◽

2021 ◽

pp. 70-72

Author(s):

M. Sabrena ◽

G.Varaguna Pandian ◽

G.V. Bharadwaj ◽

V. Swathika ◽

S. Sudhishnaa ◽

...

Keyword(s):

Fistula Tract ◽

Age Group ◽

Anal Fistulas ◽

Male Population ◽

Exclusion Criteria ◽

College Hospital ◽

Medical College ◽

Fourth Decade ◽

Intersphincteric Fistula ◽

A Prospective Study

The study was conducted on 164 patients who underwent LIFTin the Fourth unit of Department of General Surgery, Chengalpattu Medical College Hospital from Jan 2019 to Dec 2019. The aim of the study was to evaluate effectiveness of ligation of intersphincteric stula tract (lift) in anal stulas”. The study was conducted by performing LIFTamong 164 patients after satisfying the inclusion and exclusion criteria. In this study, Fistula in ano was more common among the male population with mean age group being the third and the fourth decade. Postoperatively, there was minimal signicant development in wound infection. As a consequence, the stay in the hospital was reduced and so the overall expenditure for patients is decreased. To summarize, the ligation of the intersphincteric stula tract technique for stula in ano appears to be effective, safe and easy to perform with encouraging early outcomes.

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A study on outcome of primary closure versus open fistulectomy in low level fistula in ano

International Surgery Journal ◽

10.18203/2349-2902.isj20201166 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1015 ◽

Cited By ~ 1

Author(s):

Maruti Basa ◽

Karnati Prakash

Keyword(s):

Primary Closure ◽

Classical Method ◽

Surgical Techniques ◽

Healing Time ◽

Fistula Tract ◽

Fistula In Ano ◽

Group I ◽

Time Period ◽

Surgical Units ◽

Long Time

Background: Fistula-in-ano is one of the common ano-rectal disorder which causes appreciable morbidity and inconvenience to the patient. Different surgical techniques have been described in literature from time to time. Open fistulectomy though considered as the standard treatment for fistula in-ano, fistulectomy with primary closure has its merits of short hospital stay, early wound healing and lower costs. The objectives of this study was to compare the period of stay, period of healing, time period to return to daily activities and cost factor between open fistulectomy and primary closure technique.Methods: Patients admitted in all surgical units of NIMRA Hospital, were included in the study without bias on a serial basis. This is a study comprising 50 patients over a period of 12 months from Febrauary 2019 to January 2020.Results: The patients were divided into two equal and comparable groups. Patients who underwent open fistulectomy were classified under Group I and those who underwent fistulectomy with primary closure were classified as Group II. The patient’s characteristics of the two groups were well matched.Conclusions: In patients treated by classical method because of long time taken to heal, number of hospital visits for dressings were more and more antibiotics were prescribed when compared to cases treated by excision of fistula tract and primary closure. From this study it can be concluded that fistulectomy with primary closure is ideal for low anal fistulaures.

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Comparative study on efficacy of fistulotomy and Ligation of intersphincteric fistula tract (LIFT) procedure in management of fistula-in-ano

International Surgery Journal ◽

10.18203/2349-2902.isj20174505 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3406

Author(s):

Vinay G. ◽

Balasubrahmanya K. S.

Keyword(s):

Comparative Study ◽

Anal Incontinence ◽

Healing Time ◽

Fistula Tract ◽

Chi Square ◽

Fistula In Ano ◽

Chi Square Test ◽

Average Operative Time ◽

Rectal Cancers ◽

Intersphincteric Fistula

Background: Fistula-in-ano is one of the most common benign anal conditions in daily surgical practice. Present study aims at comparing the efficacy of open fistulotomy and ligation of intersphincteric fistula tract (LIFT) procedure based on its post-operative outcomes.Methods: A comparative study was carried out among 50 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex diagnosed with anal fistula were included in the study. Patients with recurrent fistulas, Crohn’s disease, anal or distal rectal cancers were excluded from the study. Descriptive statistics, unpaired t-test, Fischer exact chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 44.6±8.34 and 41.3±9.71 years among fistulotomy and LIFT procedure group respectively. The gender distribution showed a higher number of males (38) as compared to females (12). There was 23 inter-sphincteric, 2 trans-sphincteric fistula in fistulotomy group and 22 inter-sphincteric, 3 trans-sphincteric fistula in LIFT group. The average operative time for fistulotomy was significantly shorter at 19.6 minutes, compared with 28.4 minutes for LIFT procedure. Wound infection detected in 1 (4%) and 2 (8%) subjects in fistulotomy and LIFT groups, respectively. 1 (4%) subject among fistulotomy group developed anal incontinence. The average healing time for fistulotomy was 8 weeks compared to 3 weeks for LIFT procedure. Total 3 (12%) subjects developed recurrence in LIFT procedure, but no recurrence was observed in fistulotomy group.Conclusions: LIFT procedure is effective and sphincter saving technique for fistula in ano with shorter healing time and lower incidence of postoperative anal incontinence, as compared to open fistulotomy.

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Cell therapy in surgical treatment of fistulas. Preliminary results

Polish Journal of Surgery ◽

10.5604/01.3001.0010.1019 ◽

2017 ◽

Vol 89 (3) ◽

pp. 48-51 ◽

Cited By ~ 4

Author(s):

Marcin Piejko ◽

Michał Romaniszyn ◽

Julia Borowczyk-Michałowska ◽

Justyna Drukała ◽

Piotr Wałęga

Keyword(s):

Surgical Treatment ◽

Cell Therapy ◽

Subcutaneous Tissue ◽

Perianal Fistula ◽

Fistula Tract ◽

Invasive Treatment ◽

Recurrent Fistula ◽

Intestinal Continuity ◽

Natural Healing

Risk of recurrence after surgical treatment of a recurrent fistula is up to 50%. It has be known that more aggressive surgical treatment is associated with a high risk of anal sphincter damage and leads to incontinence. Several studies have been designed to elaborate minimally invasive treatment of rectovaginal and anal fistulas. The properties of Adipose-derived Stem Cells (ASC) significantly enhance a natural healing potency. Here, we present our experience with combined surgical and cell therapy in the treatment of fistulas. Materials and Methods: Four patients were enrolled in our study after unsuccessful treatments in the past – patients 1-3 with rectovaginal fistulas including two women after graciloplasty, and patient 4 - a male with complex perianal fistula. Adipose tissue was obtained from subcutaneous tissue. ASCs were isolated, cultured up to 10+/-2 mln cells and injected into the walls of fistulas. Follow-up physical examination and anoscopy were performed at 1, 4, 8, and 12 weeks, 6 and 12 months after implantation. Results: Up to 8 weeks after ASC implantation, symptoms of fistulas’ tracts disappeared. At 8 weeks, in patients 1-3, communication between vaginal and rectal openings was closed and at 12-16 w. intestinal continuity was restored in patient 3 and 4. After a 6-month follow-up, the fistula tract of patient 4 was closed. Up to 12 m. after ASC implantation no recurrences or adverse events were observed. Conclusion: ASCs combined with surgical pre-treated fistula tracts were used in four patients. All of them were healed. This encouraging result needs further trials to evaluate the clinical efficiency and the cost-effectiveness ratio.

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The ligation of the intersphinetric tract procedure of the perianal fistula: Case report

Medicinski pregled ◽

10.2298/mpns1610298s ◽

2016 ◽

Vol 69 (9-10) ◽

pp. 298-301

Author(s):

Momcilo Stosic ◽

Igor Stojanovic ◽

Svetlana Mihajlovic

Keyword(s):

Case Report ◽

Perianal Fistula ◽

Perianal Abscess ◽

Advancement Flap ◽

Fistula Tract ◽

Lithotomy Position ◽

Main Challenge ◽

Intersphincteric Fistula ◽

Combination Of Methods ◽

First Time

Introduction. Perianal fistula is usually of cryptoglandular origin, namely it results from inflammation of the anal glands. The main challenge in its management is how to resolve a fistula but avoid its recurrence as well as incontinence, which is even a bigger problem. Several treatment methods have been described and they all focus on cutting the anal sphincter and ?opening? the fistula, placing the seton, plug technique, creating a mucosal advancement flap, injecting medical occlusive agents or using a combination of methods. In 2007 a method of managing a fistula by ligation of the intersphincteric fistula tract was described. The procedure is still getting a wider application. Case Report. A 60-year old male patient had had a fistula for 30 years. He underwent incision of perianal abscess on multiple occasions resulting in multiple scars in the gluteus area. The diagnosis revealed a high transsphincteric fistula. The inner ostium was diagnosed by injecting hydrogen-peroxide and by probing. The patient?s general condition was satisfactory. For the first time the ligation of intersphincteric fistula tract procedure was applied in our regional hospital. Under general anesthesia, in a lithotomy position, the ligation of intersphincteric fistula tract procedure was successfully performed in approximately 30 minutes. The external opening of the fistula and the scars were widely excised. The postoperative course was uneventful. After 6 months there was no recurrence. Conclusion. The ligation of intersphincteric fistula tract procedure for transsphincteric fistulae can be a treatment of choice in all hospitals treating colorectal patients because the incontinence risk is low and the disease is curable at a high percentage.

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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 for High Transsphincteric Fistula Yields Moderate Results at Best

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000001448 ◽

2019 ◽

Vol 62 (10) ◽

pp. 1231-1237 ◽

Cited By ~ 6

Author(s):

Kevin W.A. Göttgens ◽

Dareczka K. Wasowicz ◽

Jasper Stijns ◽

David Zimmerman

Keyword(s):

Fistula Tract ◽

Transsphincteric Fistula ◽

Intersphincteric Fistula

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