Long-term Results of Ligation of Intersphincteric Fistula Tract (LIFT) Versus Traditional Fistulotomy for Fistula-in-Ano
Keywords:
Fistula-in-ano, ligation of intersphincteric fistula tract, FistulotomyAbstract
Objective: To determine and compare the post-operative outcomes for a LIFT operation and traditionalfistulotomy for treatment of anal fistulas.
Background: No single technique is appropriate for the treatment of all fistula-in-ano cases; therefore, treatment
must be determined by the etiology and anatomy of the fistula, degree of symptoms, patient co-morbidities, recurrence
rate, incontinence rate and the surgeon’s experience. LIFT is a new technique that has the advantages of anal sphincter
preservation and less extensive surgery. This current study compares LIFT with traditional fistulotomy.
Material and Methods: We retrospectively studied 64 fistula-in-ano patients who underwent surgery. All cases took
place between July 20, 2008 and June 30, 2009. Patient characteristics, including sex, age, fistula-in-ano classification,
operative time, healing time, recurrence rate, incontinence rate and any complications, were obtained by reviewing each
patient’s medical record.
Results: Thirty-two patients underwent the LIFT procedure, and 32 patients underwent fistulotomy. The mean
patient age was 38.84 ± 9.64 years in the LIFT group and 36.18 ± 12.14 years in the fistulotomy group (P = 0.337). The
majority of cases were simple fistula-in-ano. Simple fistula-in-ano cases comprised 78.1% of the LIFT group and 81.3%
of the fistulotomy group (P = 1.000). The fistula tract shape was typically straight (90.6%) and was equally prevalent in
both groups (P = 1.000). The fistula tract length from anal verge was 3.10 ± 1.78 cm in the LIFT group. The most frequent
internal opening site of the LIFT group was at 6 o′ clock (31.3%). The most frequent external opening site of the LIFT
group was at 5 o′ clock. The number of external openings was not different between the groups (P = 0.173). The healing
time was 33.54 ± 8.18 days for the LIFT group and 29.90 ± 9.76 days for the fistulotomy group (P = 0.290). The healing
rate was 81.2% and the local failure rate was 18.3% in the LIFT group. The recurrence rate was 9.4% in the fistulotomy
group, and there was no recurrence in the LIFT group. There were no incontinence cases for either group.
Conclusion: The LIFT technique preserves the anal sphincter muscle for fistula-in-ano patients. The procedure
is safe, shows minimal complications, no recurrence and no incontinence when compared with traditional fistulotomy.
References
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parameters for the management of perianal abscess and
fistula-in-ano. Dis Colon Rectum 2011;54(12):1465-74.
2. Rojanasakul A, Pattanaarun J, Sahakitrungruang C,
Tantiphlachiva K. Total anal sphincter saving technique for
fistula-in-ano; the ligation of intersphincteric fistula tract. J
Med Assoc Thail 2007;90(3):581-6.
3. Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of
ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano.
Dis Colon Rectum 2013;56(3):343-7.
4. Shanwani A, Nor AM, Nil Amri MK. Ligation of the
intersphincteric fistula tract (lift): A sphincter-saving technique
for fistula-in-ano. Dis Colon Rectum 2010;53(1):39-42.
5. Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB. The anatomy of
failures following the ligation of intersphincteric tract
technique for anal fistula: A review of 93 patients over 4
years. Dis Colon Rectum 2011;54(11):1368-72.
6. Rojanasakul A. LIFT procedure: A simplified technique for
fistula-in-ano. Tech Coloproctol 2009;13(3):237-40.
7. Bleier JIS, Moloo H, Goldberg SM. Ligation of the
intersphincteric fistula tract: An effective new technique for
complex fistulas. Dis Colon Rectum 2010;53(1):43-6.
8. Garcia-Aguilar J, Belmonte C, Douglas Wong W, Goldberg
SM, Madoff RD. Anal fistula surgery: Factors associated with
recurrence and incontinence. Dis Colon Rectum 1996;
39(7):723-9.
9. Davies M, Harris D, Lohana P, Chandra Sekaran TV, Morgan
AR, Beynon J, et al. The surgical management of fistula-inano
in a specialist colorectal unit. Int J Colorectal Dis
2008;23(9):833-8.
10. Hyman N, O’Brien S, Osler T. Outcomes after fistulotomy:
Results of a prospective, multicenter regional study. Dis
Colon Rectum 2009;52(12):2022-7.
11. Sahakitrungruang C, Pattana-arun J, Khomvilai S,
Tantiphlachiva K, Atittharnsakul P, Rojanasakul A.
Marsupialization for simple fistula in ano: A randomized
controlled trial. J Med Assoc Thai 2011;94(6):699-703.
12. Sirikurnpiboon S, Awapittaya B, Jivapaisarnpong P. Ligation
of intersphincteric fistula tract and its modification: Results
from treatment of complex fistula. World J Gastrointest Surg
2013;5(4):123.
13. Theerapol A, So BY, Ngoi SS. Routine use of setons for the
treatment of anal fistulae. Singapore Med J 2002;43(6):
305-7.
14. Eitan A, Koliada M, Bickel A. The use of the loose seton
technique as a definitive treatment for recurrent and
persistent high trans-sphincteric anal fistulas: A long-term
outcome. J Gastrointest Surg 2009;13(6):1116-9.
15. Dudukgian H, Abcarian H. Why do we have so much
trouble treating anal fistula? World J Gastroenterol
2011;17(28):3292-6.
parameters for the management of perianal abscess and
fistula-in-ano. Dis Colon Rectum 2011;54(12):1465-74.
2. Rojanasakul A, Pattanaarun J, Sahakitrungruang C,
Tantiphlachiva K. Total anal sphincter saving technique for
fistula-in-ano; the ligation of intersphincteric fistula tract. J
Med Assoc Thail 2007;90(3):581-6.
3. Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of
ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano.
Dis Colon Rectum 2013;56(3):343-7.
4. Shanwani A, Nor AM, Nil Amri MK. Ligation of the
intersphincteric fistula tract (lift): A sphincter-saving technique
for fistula-in-ano. Dis Colon Rectum 2010;53(1):39-42.
5. Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB. The anatomy of
failures following the ligation of intersphincteric tract
technique for anal fistula: A review of 93 patients over 4
years. Dis Colon Rectum 2011;54(11):1368-72.
6. Rojanasakul A. LIFT procedure: A simplified technique for
fistula-in-ano. Tech Coloproctol 2009;13(3):237-40.
7. Bleier JIS, Moloo H, Goldberg SM. Ligation of the
intersphincteric fistula tract: An effective new technique for
complex fistulas. Dis Colon Rectum 2010;53(1):43-6.
8. Garcia-Aguilar J, Belmonte C, Douglas Wong W, Goldberg
SM, Madoff RD. Anal fistula surgery: Factors associated with
recurrence and incontinence. Dis Colon Rectum 1996;
39(7):723-9.
9. Davies M, Harris D, Lohana P, Chandra Sekaran TV, Morgan
AR, Beynon J, et al. The surgical management of fistula-inano
in a specialist colorectal unit. Int J Colorectal Dis
2008;23(9):833-8.
10. Hyman N, O’Brien S, Osler T. Outcomes after fistulotomy:
Results of a prospective, multicenter regional study. Dis
Colon Rectum 2009;52(12):2022-7.
11. Sahakitrungruang C, Pattana-arun J, Khomvilai S,
Tantiphlachiva K, Atittharnsakul P, Rojanasakul A.
Marsupialization for simple fistula in ano: A randomized
controlled trial. J Med Assoc Thai 2011;94(6):699-703.
12. Sirikurnpiboon S, Awapittaya B, Jivapaisarnpong P. Ligation
of intersphincteric fistula tract and its modification: Results
from treatment of complex fistula. World J Gastrointest Surg
2013;5(4):123.
13. Theerapol A, So BY, Ngoi SS. Routine use of setons for the
treatment of anal fistulae. Singapore Med J 2002;43(6):
305-7.
14. Eitan A, Koliada M, Bickel A. The use of the loose seton
technique as a definitive treatment for recurrent and
persistent high trans-sphincteric anal fistulas: A long-term
outcome. J Gastrointest Surg 2009;13(6):1116-9.
15. Dudukgian H, Abcarian H. Why do we have so much
trouble treating anal fistula? World J Gastroenterol
2011;17(28):3292-6.
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Published
2014-06-30
How to Cite
1.
Laiwattanapaisal S. Long-term Results of Ligation of Intersphincteric Fistula Tract (LIFT) Versus Traditional Fistulotomy for Fistula-in-Ano. Thai J Surg [Internet]. 2014 Jun. 30 [cited 2024 Dec. 23];35(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226376
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