scholarly journals Sphincter Preserving Techniques in Anal Fistula Treatment

2021 ◽  
Author(s):  
Dorian Kršul ◽  
Damir Karlović ◽  
Đordano Bačić ◽  
Marko Zelić
Keyword(s):  
Anal Fistula ◽  
Advancement Flap ◽  
High Rate ◽  
Fistula Tract ◽  
Colorectal Surgeon ◽  
Intersphincteric Fistula ◽  
Fistula Treatment ◽  
Meta Analyses ◽  
Methods Of Treatment

Complex anal fistulas present a challenge to even a seasoned colorectal surgeon due to high rate of recurrence and a real possibility of fecal incontinence if treated with conventional methods (e.g., fistulotomy, fistulectomy, seton placement). Although the illness is benign in nature, it can significantly decrease patient’s quality of life because of symptoms like pain and soiling. Given those facts, minimally invasive or sphincter preserving methods of treatment were introduced. Some of these include: Video-assisted anal fistula treatment (VAAFT), ligation of intersphincteric fistula tract (LIFT), Fistula-tract laser closure (FILAC), rectal advancement flap (RAF), treatment with platelet cells and combinations of techniques. This chapter would be an overview of these novel techniques with reference to latest clinical trials and meta-analyses.

Tu1763 Results of Ligation of Intersphincteric Fistula Tract and Advancement Flap for Treatment of Complex Transsphincteric Anal Fistula: Anatomy of the Recurrence

2015 ◽  
Vol 148 (4) ◽  
pp. S-1176
Author(s):  
Darcy Shaw ◽  
Charles Ternent ◽  
Sean Langenfeld ◽  
Garnet Blatchford ◽  
Jennifer S. Beaty ◽  
...  
Keyword(s):  
Anal Fistula ◽  
Advancement Flap ◽  
Fistula Tract ◽  
Intersphincteric Fistula

Treatment of Refractory Perianal Fistulas with Ligation of the Intersphincteric Fistula Tract: Preliminary Results

2013 ◽  
Vol 79 (7) ◽  
pp. 723-727 ◽  
Author(s):  
Michael L. Campbell ◽  
Elia Charbel Abboud ◽  
Michael E. Dolberg ◽  
Jaime E. Sanchez ◽  
Jorge E. Marcet ◽  
...  
Keyword(s):  
Success Rate ◽  
Anal Fistula ◽  
Advancement Flap ◽  
Fistula Tract ◽  
Success Rates ◽  
End Points ◽  
Perianal Fistulas ◽  
Fistula Plug ◽  
Variable Success ◽  
Intersphincteric Fistula

Several surgical options exist for management of fistula in ano. The goal of treatment is to achieve closure of the fistula while maintaining continence. Sphincter-sparing operations to close perianal fistulas include advancement flap, anal fistula plug, fibrin glue, and fistulectomy. Variable success rates from 30 to 80 per cent have been reported. Ligation of intersphincteric fistula tract (LIFT), first described in 2007, has a reported success rate from 40 to 94 per cent. The objective of this study was to study our results of the LIFT procedure for refractory perianal fistulas. We conducted a retrospective 18-month review of consecutive patients with refractory perianal disease treated with the LIFT procedure at an academic, tertiary, colorectal practice. All patients undergoing a LIFT procedure for anal fistula from August 2010 to August 2012 were included in the study. The primary end points were success rates at 1 month and 3 months. Secondary end points were postoperative complications and maintenance of continence. Twenty patients underwent LIFT procedures of whom nine had previously failed treatments. Mean age was 45 years and included 12 male and eight female patients. Success rate at 1 month was 70 per cent (14 patients) and at 3 months was 80 per cent (16 patients). Success rates for patients with previously failed attempts were 67 per cent at 1 month and 89 per cent at 3 months. Continence was maintained in 100 per cent of patients. Our data support the use of the LIFT procedure for refractory perirectal fistulas.

scholarly journals Сучасні методи хірургічного лікування поєднаної патології анального каналу і прямої кишки

2018 ◽  
Author(s):  
M. P. Zakharash ◽  
V. V. Balytskyy ◽  
O. G. Kuryk
Keyword(s):  
Anal Fistula ◽  
Fistula Tract ◽  
Video Assisted ◽  
Intersphincteric Fistula ◽  
Fistula Treatment

Актуальність проблеми поєднаної патології анального каналу і прямої кишки  досить висока, що на сьогодні зумовлено стрімко зростаючою  кількістю проктологічних захворювань, а також відсутністю єдиного підходу щодо  хірургічного лікування цієї категорії пацієнтів. Крім того, вивченню даної проблеми присвячена досить незначна кількість публікацій з результатами наукових досліджень. Серед  ускладнень після комбінованих операційних втручань на анальному каналі і прямій кишці з приводу їх поєднаної патології найчастіше зустрічаються рубцеві стриктури анального каналу, недостатність анального сфінктера, а також  грубі рубцеві деформації періанальних і параректальних ділянок та  промежини. Впродовж останнього десятиліття широкого застосування набули “гібридні” операції в лікуванні хронічного геморою III–IV стадії в комбінації з іншою патологією анального каналу і прямої кишки. Вони включають поєднання деартеріалізації гемороїдальних вузлів із мукопексією або латексне лігування гемороїдальних вузлів, їх ліфтинг та мукопексію з видаленням супутньої патології анального каналу. У зв’язку із прогресивним розвитком сучасних технологій у практику колопроктологів почали швидко впроваджуватись такі сучасні методи хірургічного лікування аноректальної патології, як електротермічна система “Liga Sure”, ультразвуковий гармонічний скальпель “Ultra Cision”, лазерні технології в лікуванні анальних тріщин, хронічного геморою та парапроктиту (LHP, FiLaC), плазменний скальпель, біполярна системи “En Seal”, радіохвильовий скальпель “Surgitron”, а також методики LIFT (ligation of intersphincteric fistula tract) та VAAFT (Video Assisted Anal Fistula Treatment), які зменшили тривалість операцій, об’єм крововтрати, інтенсивність больового синдрому, але, на жаль, не позбавили пацієнтів таких ускладнень, як рецидиви захворювання, післяопераційні кровотечі та рубцеві стриктури анального каналу.Отже, актуальність проблеми поєднаної патології анального каналу і прямої кишки спонукає до розробки і впровадження в клінічну практику нових високоефективних методів хірургічного лікування даної патології, які б забезпечували відсутність ускладнень  в післяопераційному періоді і швидку медико-соціальну реабілітацію пацієнтів.

scholarly journals 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

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.

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

2014 ◽  
Vol 27 (2) ◽  
pp. 101-103 ◽  
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.

scholarly journals MODIFIED METHODS OF SURGICAL TREATMENT REST OF THE RECT

2020 ◽  
pp. 151-155
Author(s):  
I. A. Kryvoruchko ◽  
I. V. Sorokina ◽  
K. Y. Parkhomenko ◽  
T. N. Firsik ◽  
A. P. Bozhko
Keyword(s):  
Surgical Treatment ◽  
Anal Fistula ◽  
Fistula Tract ◽  
Rectal Fistula ◽  
Complete Excision ◽  
Modified Method ◽  
Minimal Damage ◽  
Significant Addition ◽  
Standard Techniques

Summary. The use of mini-invasive technologies for the treatment of rectal fistula prevents many postoperative complications. Complete excision of the rectal fistula is not the only important result of treatment. Ensuring a high quality of life for patients is also very important. The proposed methods of surgical correction are a significant addition to the list of existing operations. Objective. To compare and analyze the results of the treatment patients with anal fistula by using standard techniques, the modified method LIFT and excision anal fistula with biowelding. Materials and methods. A retro- and prospective study of the surgical treatment of 90 patients with uncomplicated transsphincteric anal fistula using different techniques from September 2018 to February 2020 was conducted. Results. The introduction of these methods has shown a decrease in the number of relapses. This was achieved by combining complete excision of the fistula tract and minimal damage to the sphincter complex. Conclusion. The use of combined methods of surgical treatment of rectal fistula has significant advantages over standard techniques.

Ligation of Intersphincteric Fistula Tract (LIFT): Outcome and Continence Issues in Complex Anal Fistula

2017 ◽  
Vol 8 (1) ◽  
pp. 33-37
Author(s):  
Arshad Ahmad ◽  
◽  
Ravi Kumar ◽  
Suresh Kumar ◽  
Abhinav Arun Sonkar ◽  
...  
Keyword(s):  
Anal Fistula ◽  
Fistula Tract ◽  
Complex Anal Fistula ◽  
Intersphincteric Fistula

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

2019 ◽  
Vol 14 (6) ◽  
pp. 757-763 ◽  
Author(s):  
Elise M van Praag ◽  
Merel E Stellingwerf ◽  
Jarmila D W van der Bilt ◽  
Wilhelmus A Bemelman ◽  
Krisztina B Gecse ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Advancement Flap ◽  
Fistula Tract ◽  
Recurrence Rates ◽  
Perianal Fistulas ◽  
Radiological Healing ◽  
Intersphincteric Fistula ◽  
Clinical Healing ◽  
Postoperative Incontinence

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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