Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula

Abstract

Aim: To compare healing rates between intersphincteric fistula tract (LIFT) and LIFT plus partial fistulectomy procedures.

Methods: A study of complex fistula-in-ano patients was carried out from 1(st) March 2010 to 31(th) January 2012. All operations were done by colorectal surgeons at a referral center in a Ministry of Public Health hospital. Data collected included patients' demographic details, fistula type determined by endorectal-ultrasonography, preoperative and postoperative continence status, previous operations, time between diagnosis of fistula-in-ano and operation, type of surgery, healing rates, recurrence rates, and types of failure examined by endorectal-ultrasosnography, re-operation in recurrence or failure cases, and complications.

Results: The study involved 41 patients whose average age was 40.78 ± 11.84 years (range: 21-71 years). The major fistula type was high-transsphincteric type fistula. The median follow-up period was 24 wk. The overall success rate was 83%: in the LIFT (Ligation intersphincteric fistula tract) group the success rate was 81% and in the LIFT plus (LIFT with partial coreout fistulectomy) group it was 85% (P = 0.529). The median wound-healing time was 4 wk in both groups (P = 0.262). The median time to recurrence was 12 wk. Neither group had incontinence (Wexner incontinence score-0) and the difference in healing rates between the two groups was not statistically significant.

Conclusion: There was no difference in results between LIFT and LIFT plus operations. The LIFT procedure is a good option for maintaining continence in management of fistula-in-ano.

Keywords: Complex fistula; Fistula-in-ano; Incontinence; Intersphincteric fistula tract; Perianal disease.