Abstract
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.
Highlights
An anal fistula is a persistent infectious tract developing between the anal canal and the perianal skin
Complex anal fistulas management remains a challenge for surgeons worldwide[6]
When we look at published ligation of the intersphincteric fistula tract (LIFT) procedure results for the cure of anal fistula, it remains challenging to define which patients will benefit most
Summary
An anal fistula is a persistent infectious tract developing between the anal canal and the perianal skin. Complex fistulas include high transsphincteric (>30% external sphincter involvement), suprasphincteric, or extrasphincteric fistulas. They may be defined as horseshoe, recurrent, and all anterior fistulas in women and may present with multiple tracts, or associated to Crohn’s disease, radiation therapy, or malignancy[2]. The ligation of the intersphincteric fistula tract (LIFT) procedure has been described as the most recent innovation to sphincter-preserving surgery for the management of complex anal fistulas. It was first reported by Rojanasakul et al.[7] in 2007 as a sphincter-preserving procedure, primarily indicated for transsphincteric fistulas. These authors hypothesized that the ligation and excision of the intersphincteric
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