Ligation of Intersphincteric Fistula Tract vs Endorectal Advancement Flap for High Type Fistula in Ano: A Randomized Controlled Trial (Frail Trial)

Abstract

Introduction: This study aimed to compare the postoperative outcome and success rate of Endorectal advancement flap (ERAF) and Ligation of intersphincteric fistula tract (LIFT) surgical procedures in high-type fistula in ano. Methods: This randomized control trial included the patients with high type fistula in ano of cryptoglandular origin. The primary endpoint was complete healing of the fistula at the end of 6 months. Other parameters studied were perioperative complication, duration of surgery, postoperative pain, hospital stay in hours, continence, and the quality of life. Results: A total of 84 patients were recruited (42 in each group) and followed up for at least 6 months. LIFT’s healing rate was significantly better than the ERAF group (78.5% vs 54.7%, p value < 0.05). Four patients in ERAF and 2 in the LIFT group had flatus incontinence at the end of 6 months. In the LIFT group, we observed a significantly better VAS score at the end of the first week and quality of life at 6 months (3.7±1.16 vs 4.7±0.81 & 0.7 vs 0.6, p < 0.05). The mean duration of surgery was significantly less in the LIFT group (46.43±9.32 min vs 89.29±10.90). None of them had any postoperative complication, and more than 80% were discharged within 24 hours. Conclusion: The results suggest shorter operative duration, better healing, and quality of life at six months in the LIFT group. However, further studies on all types of fistula in ano with a large sample size and an extended follow-up are recommended.