Ligation Of Intersphincteric Fistula Tract Procedure Research Articles

Effectiveness of ligation of Inter Sphincteric Fistula Tract (LIFT) in the Management of Fistulas in ano in Maharashtra Population: Retrospective Study

Background: Anal fistula is one of the most common ano- rectal problems, resulting in very negative patientexperiences. The objectives of anal fistula treatments are to achieve healing with a low recurrence rate and preserveanal function.Method: 55 adult patients were confirmed to be competent for surgery. USG examination with 7 to 10 MHZtransducer passed into the anal canal, which is carried out with the patient in the left lateral position. Serial radialimages were taken to study the location and position of the fistula. The LIFT procedure was similar to Rojanaskulproposed method. The duration of surgery and healing time were also noted.Results: 48 (87.2%) were as per Parks classification, 5 (9.09%) intersphincteric, 2 (3.63%) suprasphincteric,Classification based on course of fistula – 20 (36.3%) anterior straight, 28 (50.9%) posterior straight, 5 (9.09%) curved,and 2 (3.63%) semi-horse shoe. Classification based on the tract – 50 (90.9%) single tracts, 5 (9.09%) multiple tracts.Conclusion: LIFT technique is simple and safe, with a high rate of healing and no risk of incontinence.

Efficacy of Ligation of Inter-sphincteric Fistula Tract technique for fistula-in-ano: A prospective observational study

Background: Fistula-in-ano is one of the commonest diseases presented to the surgical outpatient department that affects the patient physically and psychologically. As the disease is known for recurrence, the ideal technique for fistula repair is still undetermined. Materials and Methods:We hereby report 85 patients diagnosed clinically and radiologically having fistula-inano who underwent the Ligation of Inter-sphincteric Fistula Tract (LIFT) procedure at a tertiary care center. Results: The median time for the LIFT procedure was 32.5 minutes (range 25-40 minutes), and the median time taken for healing of the wound was around eight weeks. The majority of patients (95.4%) had no recurrence, and only 4 (4.6%) had a recurrence on follow-up within one year. None of the patients presented with stool or flatus incontinence. Conclusion: The LIFT technique can be the preferred treatment option for fistula-in-ano that are having simple straight tract, single opening lying posteriorly, and having either trans-sphincteric or inter-sphincteric variety with lower complication rates and preserving continent anal sphincter allowing patients to return early to their routine activities normal daily activities

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

Long-term outcome of ligation of inter-sphincteric fistula tract (LIFT) for management of trans-sphincteric anal fistula

BackgroundAfter abscess formation, an anal fistula is a common consequence, with crypto-glandular infection being the most commonly accepted causative cause. The goal of this study was to see how well closure of the inter-sphincteric fistula tract affects the outcome of trans-sphincteric fistula surgery. MethodsPatients with perianal trans-sphincteric fistulas who underwent ligation of inter-sphincteric fistula tract (LIFT) were studied prospectively in this cohort study. All patients had the identical anesthetic approach, followed by LIFT with two years’ follow-up. Resultslength of the fistulous tract had a substantial effect on the result. The presence of piles with fistula among the studied patients has no effect on the outcome. Mean operative time was 36.2 min and post operative pain was mild in most patients and concomitant anal fissure or piles has no effect on final result of LIFT procedure The mean time for wound healing was four weeks. Three patients had hidradenitis suppurativa and no any unusual histopathology results shown in the excised parts. ConclusionLIFT was an effective and straightforward sphincter-preserving technique in treating simple trans-sphincteric anal fistulas with excellent long-term control of trans-sphincteric fistula. More similar studies with a large number of patients are still needed to assess this surgical technique for trans-sphincteric fistula.

A pilot randomized controlled trial on ligation of intersphincteric fistula tract (LIFT) versus modified parks technique and two-stage seton in treatment of complex anal fistula.

Complex anal fistula (CAF) is a challenging condition for surgeons. This randomized trial aimed to compare ligation of the intersphincteric fistula tract (LIFT), modified Parks technique, and two-stage seton in the treatment of complex anal fistula in terms of the success of treatment and complications. This was a pilot randomized trial conducted in the period of January 2019 to December 2019 on adult patients with CAF who were allocated to one of three groups: LIFT, modified Parks technique, and two-stage seton. The main outcome measures were healing rates, time to healing, complications, operation time, and quality of life. Sixty-six patients (75.7% males) of a mean age of 45.2years were included. Mean operation time of LIFT was significantly shorter than the other two procedures (p < 0.0001). There was a significant difference between the three groups in terms of success rate (p = 0.04) but not in regard to complications (p = 0.59). The modified Parks technique had a significantly higher success rate than LIFT (95.2% vs 68.1%, p = 0.045) whereas the success rates of two-stage seton and LIFT were not significantly different (86.9% vs 68.1%, p = 0.16). The average time to healing after LIFT was significantly shorter than the other two procedures. The quality-of-life scores were comparable among the three groups. There was a significant difference in healing rates after the three procedures as the modified Parks technique achieved the highest success rate followed by two-stage seton and then the LIFT procedure. Time to complete healing after LIFT was significantly shorter than the other two procedures. The three procedures achieved similar quality of life and complication rates.

COMPARATIVE STUDY BETWEEN LIFT PROCEDURE VERSUS SETON PLACEMENT IN THE MANAGEMENT OF FISTULA IN ANO

INTRODUCTION: A stula-in-ano, is a chronic abnormal communication, usually lined by granulation tissue, which runs outwards from the anorectal lumen. The standards of anal stula surgery are to obliterate the stula, prevent recurrence and maintain sphincter work. Ligation of Intersphincteric Fistula Tract (LIFT) is the most promising surgical technique based on secure closure of the internal opening and removal of the infected crypto glandular tissue through intersphincteric approach. AIMS: To compare the effectiveness of LIFT over SETON procedure based on Postoperative pain on day 1 and2, Short term recurrence, Healing, Procedural visits PATIENTS AND METHODS: A prospective, single centered, interventional study in 60 patients with stula-in-ano admitted to general surgical wards in Narayana Medical College and Hospital, Nellore. From November 2018 to November 2020. Patients were divided into two groups, group A including patients undergoing LIFT procedure and group B, including patients undergoing SETON placement of Fistula-in- ano. RESULTS: Maximum patients were in 41-60 years in the LIFT Group 18(60%), 51-60 years in the SETON group 12(40%). Maximum patients were male 21 in each group (70%), and female were 9 in each group (30%). In the present study, Visual Analog Scale (0,1,2,3) in LIFT group on POD 1, were 2, 20, 6, 2 and in SETON group on POD 1 were 0, 9, 16, 5 respectively. Similarly, visual analogue scale (0,1,2,3) in LIFT group on POD 2, were 19.8.3.0 and in SETON group on POD 2 were 5, 20, 5, 0respectively. Patients who underwent LIFT procedure had a satisfactory postoperative period and the wound healed in all the cases. CONCLUSION: we conclude that LIFT gives good outcomes in terms of Postoperative pain on day 1 and 2, wound healing rate, single time procedure and recurrence during our short follow-up period of 6 months.

The results of high-position anal fistula treatment using the LIFT (ligation of intersphincteric fistula tract) procedure. A retrospective, single-center study.

Ligation of the intersphincteric fistula tract (LIFT) is an established method for the treatment of high- and lowposition anal fistulas. Numerous meta-analyses confirm the high healing success rate with simultaneous low risk of sphincter damage. The aim of the study was to evaluate the results of the treatment of patients with high-position and complex transsphincteric fistulas using the LIFT procedure. Twelve patients (M - 9, F - 3) aged between 28 and 69 years (median age 50) undergoing surgery for complex and high-position transsphincteric anal fistulas, either primary or recurrent, in the period of 2016 to 2020, were included in the study. The inclusion criterion consisted in the presence of a fistula encompassing more than 30% of the anal sphincter volume as confirmed by transrectal ultrasound. All patients were subjected to surgical treatment by means of the LIFT procedure. The follow-up period was between 6 and 51 months (average of 16 months). Follow-up visits were held at 1 and 4 weeks as well as 6 months after surgery. During the postoperative period, data were collected on the curative effect or recurrence of transsphincteric fistulas (the primary endpoint) and on the presence of postoperative complications (the secondary endpoint). A total of 10 patients (83.3%) were healed, with 2 patients (16.7%) experiencing complications as manifested by recurring intersphincteric fistula. Full recurrence of the disease was observed in 2 patients (16.7%). Slight disturbances of continence were observed in 2 out of 12 patients (16.7%).

A comparative study of ligation of intersphincteric fistula tract (LIFT) and conventional fistulotomy in treatment of fistula-in-ano

Background: A hospital randomized control study was conducted at a tertiary care Hospital, to compare outcomes between the Ligation of Intersphincteric Fistula Tract (LIFT) technique and conventional fistulotomy for the treatment of low trans-sphincteric fistula in ano, including 50 patients of low trans-sphincteric fistula in ano randomly divided into two groups. LIFT technique was used in first group while Conventional Fistulotomy was performed in another. Mean duration of operation was significantly less and mean hospital stay, post-operative pain and analgesics need was significantly less in cases operated with LIFT. Mean time for complete healing was significantly less in cases operated with LIFT technique and the difference in complication rate was statistically nonsignificant. Recurrence was reported in 3 (12%) and 1 (4%) cases operated by LIFT and fistulotomy respectively. Ligation of Intersphincteric Fistula Tract (LIFT) procedure is effective and preferred sphincter saving technique for fistula-in-ano. Despite slightly more recurrence, LIFT procedure has certain advantages over standard fistulotomy like shorter operative time, less postoperative pain, shorter hospital stay and faster wound healing and early resumption of normal duties.

Reprint of: The LIFT procedure

The Ligation of Intersphincteric Fistula Tract (LIFT) procedure is a recent sphincter-preserving procedure added to the surgical armamentarium of managing anal fistulas. It has gained popularity for its simple, easy-to-learn technique and success rate reliably exceeding 70%. Studies using validated continence scores have verified its advantage in preserving continence. The procedure is aimed at the cryptoglandular source of infection within the intersphincteric space. This is achieved through a small incision parallel to the intersphincteric groove and corresponding to the internal opening. After excision of the intersphincteric portion of the fistula tract, the openings on the internal and external sphincter are suture-ligated. Wound care is simple with minimal post-operative pain. Pre-operative imaging with endoanal ultrasonography helps to position the incision. Most failures or recurrences occur in the intersphincteric wound. This can be treated successfully with simple fistulotomy. The use of a seton before a LIFT procedure has not been proven beneficial. This technique has also been applied to Crohn׳s disease-related fistulas with similar success. Modifications to the technique using bioprosthetic inserts have also been reported to confer better results albeit at a greater cost.

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

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.

Ligation of Intersphincteric Fistula Tract vs Ligation of the Intersphincteric Fistula Tract Plus a Bioprosthetic Anal Fistula Plug Procedure in Patients With Transsphincteric Anal Fistula

The purpose of this study was to compare the ligation of intersphincteric fistula tract (LIFT) with an additional plug (LIFT-plug) in the treatment of transsphincteric anal fistula. Both LIFT and LIFT-plug are recently reported effective alternatives of transsphincteric anal fistula. This multicenter prospective randomized study (NCT01478139) was conducted at 5 university hospitals throughout China. A total of 235 patients were randomly assigned to undergo LIFT (118 patients) or LIFT-plug (117 patients) between March 2011 and April 2013. The primary outcome measured was primary healing rate at 6 months postoperatively and healing time. Secondary outcomes included recurrence rate, postoperative pain, and incontinence rate. The LIFT procedure showed shorter operative time than the LIFT-plug procedure (26.7 min vs 28.5 min, P = 0.03). Median healing time was 22 days in LIFT-plug group vs 30 days in LIFT group (P < 0.001). The difference in visual analog scale scores across all time points was not statistically significant between the groups (P = 0.13). The primary healing rate was higher in LIFT-plug group than in LIFT group [94.0% (95% confidence interval 89.7%-98.3%) vs 83.9% (95% confidence interval 77.2%-90.6%), P < 0.001]. There were no reported incontinence and recurrence within the follow-up period of 6 months. In patients with transsphincteric anal fistulas, both LIFT-plug and LIFT are simple, safe, and effective procedures. LIFT-plug has the advantage of a higher healing rate, less healing time, and a lower early postoperative pain score.

The place of conventional anal fistula surgeries among modern surgical techniques included in the current anal fistula treatment algorithm

The high percentage of complications after anal fistula surgery have resulted inattempts to seek new surgical solutions, which involve both improving the existing conventional surgical methods, as well as the introduction of modern surgical techniques. Classical surgical methods, such as fistulotomy, fistulectomy and Hippocrates’ procedure (loose or cutting setons) still have their place in the modernfistula treatment algorithm, however, some of the indications have changed (e.g. Hippocrates’ technique) and even new indications have been introduced. The noveltiesare represented e.g. by the use of a loose seton as a preparatory stage in innovativesurgical techniques, such as laser obliteration, injecting stem cells into the fistula tractor ligation of intersphincteric fistula tract (LIFT). Advancement flaps were replacedby LIFT and laser techniques due to similar indications, higher efficacy and lowerinvasiveness of the latter ones. On the other hand, the LIFT procedure was replacedby laser obliteration in the treatment of non branching trans-sphincteric fistulasas a less invasive and equally effective method. Although techniques for closing thefistula tract with a plug or adhesives are still considered as minimally invasive, theyare unfortunately associated with high recurrence rates. Recently a new solutionhas appeared. It is known as BioLIFT and combines LIFT with the anal fistula plug.The estimated effectiveness of this procedure is 68.8%.

Clinical observation of the ligation of intersphincteric fistula tract in the treatment of simple anal fistula

To investigate the clinical efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of simple anal fistula, including transphincteric anal fistula and insphincteric anal fistula. Clinical data of 52 patients with anal fistula receiving surgery treatment in Beijing Anorectal Hospital from January to October 2014 were analyzed retrospectively. Adoption of surgical procedure was based on rectal endoluminal ultrasound and patients' decision. Patients were divided into LIFT group and seton group. The two groups were compared in terms of operation time, blood loss, postoperative pain score, incidence of urinary retention, wound healing time, cure rate, recurrence, and the anal incontinence score. There were 52 patients in the entire cohort including 28 cases of transphincteric anal fistula (14 cases of LIFT and seton placement groups) and 24 cases of intersphincteric anal fistula (12 case of LIFT and seton placement). The operation time was shorter in seton placement group in patients with two simple anal fistula [(23.9±5.0) min vs. (46.3±7.7) min, P<0.05]. LIFT postoperative pain score [(1.6±0.6) vs. (6.1±1.3)], wound healing time [(7.9±2.0) days vs. (30.0±5.1) days], postoperative hospital stay [(10.3±3.1) days vs. (20.7±7.1) days], and anal incontinence scores [(1.1±0.4) vs. (4.9±1.1)] were better than that of anal fistula seton (all P<0.05). There was no statistically significant difference in intraoperatie blood loss [(23.1±4.7) ml vs. (23.3±4.7) ml, P>0.05]. The cure rate of intersphincteric anal fistula was 83.3%(10/12) in LIFT group, and 100%(12/12) in the seton group. The cure rate of transphincteric anal fistula was 78.6% (11/14) in LIFT and 92.9%(13/14) in anal fistula seton group. There was no statistically significant difference (P>0.05). In the treatment of transphincteric fistula tract and intersphincteric fistula tract, LIFT procedures should be considered.

Minimally Invasive Anal Fistula Treatment—a True Minimal Invasive Surgical Procedure

A surgical procedure comprises of two aspects—the surgical access and surgery on the target organ. For decades, general surgeons focussed their minds to propel development in the latter, i.e., surgery on the target organ. Trauma due to surgical access was considered inevitable. Patient discomfort, debility, and disfigurement were considered to be a small price the patients were paying in the larger interest of surgical cure. The advent of minimal access surgery revolutionized the concept of surgical practice. The approach placed the patient at the center of all surgical decisions. It was for the first time that the comfort and needs of the patient were given paramount importance. Through minimal access surgery, the trauma of surgical access has been dramatically minimized, with shorter hospital stay and greater patient satisfaction. Today, minimal access surgery is firmly established in the armamentarium of surgeons worldwide. The early postoperative sequelae following management of anal fistulae in terms of postoperative pain, need for dressings, and time taken off work has not been reported much in literature. Mostly, long-term outcomes in terms of recurrence and incontinence have been addressed in studies reported so far. Traditional techniques including fistulectomy and use of cutting seton have been associated with incontinence, especially in patients who have had previous surgery. Mucosal advancement flaps are technically challenging and are associated with high recurrence rates and high rates of incontinence postoperatively. Although surgical field has undergone significant evolution over the past few decades, the surgical management of the perianal anomalies is yet to witness a technological breakthrough. Apart from treatment of hemorrhoids, there have not been many surgical innovations for perianal infective pathologies. The newer treatment options include use of fibrin glue, bio-prosthetic plugs, and ligation of intersphincteric fistula tract (LIFT) and video-assisted anal fistula treatment (VAAFT). LIFT procedure has been associated with good healing rates. The early results with the use of VAAFT have been encouraging so far. The video-assisted anal fistula treatment (VAAFT) was developed by Professor P. Meinero in 2006 [1]. However, we strongly feel and advocate the terminology of minimally invasive anal fistula treatment (MAFT), which is much more appropriate and is the correct description of the procedure. MAFT qualifies as a trueminimal invasive surgical procedure. There are no iatrogenic incisions for access on the patient. Surgical access is obtained from a pre-existing pathological opening of the fistula. The technique comprises identification and secure internal closure of the internal fistula opening and visualization with cauterization of the fistulous tract using a specially designed fistuloscope. The MAFT is based on the same principles as other procedures for closing the internal opening and obliterating the tract with the innovation that allows precise identification of the fistula anatomy and the internal opening by fistuloscopy and fulguration of the tract walls under direct vision. This approach allows the identification and treatment of all the secondary tracts and the abscess cavities connected to the main track. In our opinion, the adoption of fistuloscope-aided exploration along with effective closure of the internal opening and reinforcing the closure of the opening from the inner side of the staple/suture line is the most effective way of achieving a high healing rate for complex anal fistulas with preservation of the anal sphincter. We adopted the MAFT technique in April 2011 in an effort to reduce early postoperative morbidity and offer patients * P. K. Chowbey pradeepchowbey@gmail.com

Results from a novel modification to the ligation intersphincteric fistula tract

BackgroundThe ligation of intersphincteric fistula tract (LIFT) procedure for trans-sphincteric fistula-in-ano has been studied with variable success rates compared with initial reports. Failures occur mostly in the intersphincteric wound. Recently, we proposed a modification to LIFT, unroofing the fistula from internal opening to intersphincteric groove, ligating the fistula tract, but preserving the external sphincter. MethodsThis retrospective review assesses outcomes of patients undergoing the modified LIFT for trans-sphincteric fistulae. ResultsSixty-six modified LIFT procedures were performed. The main cohort consisted of 56 patients, predominantly men (76.7%). Median operative time was 16 minutes. Median follow-up was 20.98 weeks. Overall cure rate was 71.42%, with a recurrence rate of 5.35% and fistula persistence in 16.07%. There was no persistent fecal incontinence. ConclusionModified LIFT is a safe procedure that is easily performed, has short operative time, eliminates the intersphincteric space, and has cure rates equal to or better than the original LIFT.

Ligation of intersphincteric fistula tract in the treatment of complicated fistula-in-ano

To evaluate the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of complex fistula-in-ano. Clinical data of 24 patients with complex fistula-in-ano who treated with LIFT in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2009 to February 2012 were analyzed retrospectively. The operative efficacy and postoperative continence were evaluated. The prime success rate of fistula healing was 66.7% (16/24) after the LIFT procedure. Two patients presented with intersphincteric incision infection which was successfully treated with topical of silver nitrate. Four patients had intersphincteric fistula with infection and managed with the complete laying open approach. The total clinical healing rate was 91.7% (22/24). Another 2 patients had persistent external opening with discharge. During follow-up of 6 to 44 (median 16) months, The Cleveland Clinic Florida Fecal Incontinence score revealed that no patient developed decreased continence. LIFT is a safe and effective sphincter-preserve procedure for complex fistula-in-ano.

The LIFT procedure

The Ligation of Intersphincteric Fistula Tract (LIFT) procedure is a recent sphincter-preserving procedure added to the surgical armamentarium of managing anal fistulas. It has gained popularity for its simple, easy-to-learn technique and success rate reliably exceeding 70%. Studies using validated continence scores have verified its advantage in preserving continence. The procedure is aimed at the cryptoglandular source of infection within the intersphincteric space. This is achieved through a small incision parallel to the intersphincteric groove and corresponding to the internal opening. After excision of the intersphincteric portion of the fistula tract, the openings on the internal and external sphincter are suture-ligated. Wound care is simple with minimal post-operative pain. Pre-operative imaging with endoanal ultrasonography helps to position the incision. Most failures or recurrences occur in the intersphincteric wound. This can be treated successfully with simple fistulotomy. The use of a seton before a LIFT procedure has not been proven beneficial. This technique has also been applied to Crohn׳s disease-related fistulas with similar success. Modifications to the technique using bioprosthetic inserts have also been reported to confer better results albeit at a greater cost.

Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis.

Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5%, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.

Systematic review of efficacy of LIFT procedure in crpytoglandular fistula-in-ano

Backgroundfistula-in-ano is a common problem. Ligation of intersphincteric fistula tract (LIFT) is a new addition to the list of operations available to deal with complex fistula-in-ano. Objectivewe sought to qualitatively analyze studies describing LIFT for crpytoglandular fistula-in-ano and determine its efficacy. Data sourcesMEDLINE (Pubmed, Ovid), Embase, Scopus and Cochrane Library were searched. Study selectionall clinical trials which studied LIFT or compared LIFT with other methods of treatment for anal fistulae, prospective observational studies, clinical registry data and retrospective case series which reported clinical healing of the fistula as the outcome were included. Case reports, studies reporting a combination with other technique, modified technique, abstracts, letters and comments were excluded. Interventionthe intervention was ligation of intersphincteric fistula tract in crpytoglandular fistula-in-ano. Main outcome measureprimary outcome measured was success rate (fistula healing rate) and length of follow-up.

New Techniques in Anal Fistula Management

Context: The management of complicated anal fistula is a serious issue in coloproctology. Various methods have been described but the choice must be made based on the course of the fistula tract in relation to the sphincter. As anal fistulas are caused by anal gland infection, the anal gland and ducts should be removed for the process of healing to begin and for the anal sphincter preservation. The aim of this study is to briefly explain and assess three new sphincter preserving surgical treatments, including fibrin glue and anal plug techniques and the procedure of ligation of intersphincteric fistula tract (LIFT) and also to evaluate the failure and success rates of these techniques. Evidence Acquisition: We conducted a search in the literature of the last decade, in the PubMed database, using the keywords: anal Fistula, LIFT procedure, fibrin glue and anal plug. Results: Using anal fistula plug provides another option for the treatment of complex anal fistulas and does appear to be an effective technique in some cases. The technique of intersphincteric fistula tract ligation as a fistula treatment surgery, aims for total anal sphincter preservation and appears to be both safe and easy to perform, with encouraging early outcomes. The authors suggest further controlled studies comparing the LIFT procedure with standard therapies. Conclusions: Fibrin sealant injection should be in the armamentarium of the specialists' surgical treatments for fistula-in-ano. The surgeons and their patient should be aware of the limited success expectations, when using fibrin glue technique as the treatment.