Clinical science
Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage

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Abstract

Background

The ligation of intersphincteric fistula tract (LIFT) is a relatively new surgical technique for treating complex anorectal fistulas.

Methods

LIFT was compared with anorectal advancement flap management (ARAF) of complex anorectal fistulas requiring previous seton drainage. Crohn's patients were excluded. Patients with no confirmed recurrent sepsis after 6 months were randomized to day surgery performance of LIFT (25; 17 male) or ARAF (14; 10 male) with removal of the seton. Outcome measures included recurrences, surgical time, complications, hospital readmissions, and fecal incontinence.

Results

LIFT was 32.5 minutes shorter than ARAF (P < .001). Complications were similar, with no hospital readmissions. Return to normal activities was 1 week for LIFT patients, 2 weeks for ARAF patients (P = .016). At 19 months there were 3 recurrences (2 in the LIFT group). One ARAF patient had minor incontinence.

Conclusions

The LIFT procedure was simple, safe, shorter, and patients returned to work earlier. All patients had preliminary seton drainage, possibly contributing to the low recurrence rates.

Section snippets

Participants

Participants were patients attending a regional hospital outpatient surgery between December 2007 and February 2011 for treatment of complex fistula-in-ano arising from cryptoglandular infections. All patients were informed about the procedures, and written consent meeting the standards set by the hospital's institutional review board was obtained. Patients with trans-sphincteric or complex fistulas were included in the study. Patients with Crohn's disease were excluded from the study because

Results

Between December 2007 and February 2011, 39 patients (27 men; mean age, 47.8 y; SD, 13.0 y) were randomized with 25 (17 male) in the LIFT group and 14 (10 male) in the ARAF group (Fig. 1, Table 1). There were no significant differences in age, sex, or comorbidities between the 2 groups (Table 1). The comorbidities included ischemic heart disease, atrial fibrillation, dyslipidemia, asthma, diabetes mellitus, bowel cancer, and rheumatoid arthritis.

In addition, there were no differences in the

Comments

The major findings from this study were that the LIFT technique for the management of anal fistulas can be performed more rapidly and results in a better quality of life for the patient with less pain, a better satisfaction score, and faster resumption of normal activities than the ARAF technique. Although the overall recurrence rate was low (7.7%), there was no difference in recurrence rate between the 2 procedures.

The LIFT technique divides the fistula tract in the intersphincteric space and

Conclusions

There was no significant difference in recurrence rates between the LIFT and ARAF procedures. This randomized study of LIFT includes the management of complex fistula-in-ano. The study supports LIFT as a simple and safe treatment option in the management of trans-sphincteric fistula. This procedure can be performed quickly and results in a better quality of life for the patient. Initial seton drainage may have contributed to our favorable early midterm results with low recurrence rates after

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    • Cited by (0)

    Chrispen Mushaya, Bettina Schulze, and Yik-Hong Ho designed and performed the research; Lynne Bartlett analyzed the data; Chrispen Mushaya, Bettina Schultze, and Lynne Bartlett drafted the paper; Yik-Hong Ho critically revised the paper for important intellectual content, and all authors contributed to the work and agreed on the final version.

    There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

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