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

Abstract

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