Management of anal fistula by ligation of the intersphincteric fistula tract - a systematic review

Abstract

Introduction: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treatment of anal fistulas described in 2007 by Rojanasakul et al. Several studies have since then assessed the procedure with varied results. This review assesses the relevant literature on this topic.

Methods: The primary endpoints were healing rates, length of follow-up, time to recurrence and post-operative complications. The secondary endpoints were details of the operative technique. A search was made in the PubMed and Embase electronic databases. Reports where LIFT was combined with other fistula treatment techniques were excluded. Only reports in English were included. Most reports were case studies with no control groups. One report could not be retrieved.

Results: A total of 19 original reports were assessed. Details concerning preoperative assessment, antibiotic usage and tract ligation methods varied considerably. Primary healing was achieved in 432 out of 612 (70.6%) patients, and no sphincter function impairments were reported. However, ten out of 19 reports did not include an objective assessment of pre- and post-operative continence. No apparent correlation between length of follow-up and healing rate was found, and the longest time to recurrence was eight months.

Conclusion: LIFT is a safe procedure that provided a mean healing of 70.6% with no reports of impairment of the sphincter function. Future reports should include a follow-up length of a minimum of eight months. It remains uncertain whether the outcome may be improved by prior seton suture insertion.