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Appraisal of the LIFT and BIOLIFT procedure: initial experience and short-term outcomes of 33 consecutive patients

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

A new sphincter-saving technique known as the LIFT (ligation of intersphincteric tract) procedure has gained growing interest. Use of a bioprosthetic device has also been suggested to augment the LIFT procedure (BIOLIFT). This study evaluates outcomes of patients undergoing LIFT and BIOLIFT for repair of complex anal fistulae.

Methods

This study is a single-surgeon, single-centre retrospective review of a prospectively collected database. Study was conducted at Royal Prince Alfred Hospital Department of Colorectal Surgery, Sydney, Australia, from May 2009 to April 2012. Thirty-three patients were evaluated. Twenty-nine LIFTs and five BIOLIFT procedures were evaluated. Primary success is defined as successful healing from initial procedure while secondary success is successful healing after management of failure or recurrence.

Results

In a cohort of predominantly female (67 %) and 94 % transsphincteric fistulae, primary success was 63 %. At a median follow-up of 20 weeks (6–81 weeks), there were 11 failures and one recurrence. The median time to failure/recurrence was 3 weeks (1–25 weeks). Six patients had a subsequent fistulotomy and three patients had a BIOLIFT for non-successful outcomes. The median follow-up for those with failures/recurrences is 60 weeks (range 20–76 weeks) and secondary success was 88 %. Post-operative anal manometry studies showed a 9 % reduction of resting and 11 % reduction of squeeze pressures but this was not statistically significant. There was also no post-operative incontinence. Anterior fistulas were noted do significantly worse (47%) compared with non-anteriorly located fistulas (84 %; p = 0.03).

Conclusions

LIFT and BIOLIFT procedures can be performed safely and effectively in a technically demanding study cohort of predominantly females with complex fistulas. Anterior fistulas have a higher risk of failure but present early and are amendable to repeat procedures. In particular, fistulotomies are useful in downstaged tracts and performing BIOLIFTs is an alternative in the management of LIFT failures and recurrences

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References

  1. Whiteford MH, Kilkenny J 3rd, Hyman N et al (2005) Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum 48(7):1337–1342

    Article  PubMed  Google Scholar 

  2. Rojanasakul A, Pattanaarun J, Sahakitrungruang C et al (2007) Total anal sphincter saving technique for fistula-in-ano: the ligation of intersphincteric fistula tract. J Med Assoc Thai 90:581–586

    PubMed  Google Scholar 

  3. Rojanasakul A (2009) LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol 13:237–240

    Article  PubMed  CAS  Google Scholar 

  4. Shanwani A, Nor AM, Amri N (2010) Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum 53:39–42

    Article  PubMed  CAS  Google Scholar 

  5. Aboulian A, Kaji AH, Kumar RR (2011) Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum 54:289–292

    Article  PubMed  Google Scholar 

  6. Bleier JI, Moloo H, Goldberg SM (2010) Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum 53(1):43–46

    Article  PubMed  Google Scholar 

  7. Sileri P, Franceschilli L, Angelucci GP et al (2011) Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study. Tech Coloproctol 15(4):413–416

    Article  PubMed  CAS  Google Scholar 

  8. Ellis CN (2008) Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum 5:1084–1088

    Article  Google Scholar 

  9. Ellis CN (2010) Outcomes with the use of bioprosthetic grafts to reinforce the ligation of the intersphincteric fistula tract (BIOLIFT Procedure) for the management of complex anal fistulas. Dis Colon Rectum 53(10):1361–1364

    Article  PubMed  Google Scholar 

  10. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula in-ano. Br J Surg 63:1–12

    Article  PubMed  CAS  Google Scholar 

  11. van Koperen PJ, Wind J, Bemelman WA, Bakx R, Reitsma JB, Slors JF (2008) Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon Rectum 51:1475–1481

    Article  PubMed  Google Scholar 

  12. Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB (2011) 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 54(11):1368–1372

    Article  PubMed  Google Scholar 

  13. Roig JV, Jordán J, García-Armengol J, Esclapez P, Solana A (2009) Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery. Dis Colon Rectum 52(8):1462–1469

    Article  PubMed  Google Scholar 

  14. Quah HM, Tang CL, Eu KW, Chan SY, Samuel M (2006) Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula. Int J Color Dis 21(6):602–609

    Article  CAS  Google Scholar 

  15. Soltani A, Kaiser AM (2010) Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum 53(4):486–495

    Article  PubMed  Google Scholar 

  16. Malouf AJ, Buchanan GN, Carapeti EA et al (2002) A prospective audit of fistula-in-ano at St. Mark’s hospital. Colorectal Dis 4(1):13–19

    Article  PubMed  Google Scholar 

  17. Vial M, Parés D, Pera M, Grande L (2010) Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorectal Dis 12(3):172–178

    Article  PubMed  CAS  Google Scholar 

  18. Ommer A, Wenger FA, Rolfs T, Walz MK (2008) Continence disorders after anal surgery—a relevant problem? Int J Color Dis 23:1023–1031

    Article  CAS  Google Scholar 

  19. Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532

    Article  PubMed  CAS  Google Scholar 

  20. Tjandra JJ, Dykes SL, Kumar RR et al (2007) Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum 50:1497–1507

    Article  PubMed  Google Scholar 

  21. Mitalas LE, van Wijk JJ, Gosselink MP, Doornebosch P, Zimmerman DD, Schouten WR (2010) Seton drainage prior to transanal advancement flap repair: useful or not? Int J Color Dis 25:1499–1502

    Article  Google Scholar 

  22. Mitalas LE, Schouten SB, Gosselink MP, Oom DM, Zimmerman DD, Schouten WR (2009) Does rectal blood flow affect the outcome of transanal advancement repair? Dis Colon Rectum 52:1395–1399

    Article  PubMed  Google Scholar 

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Conflicts of interest and source of funding

This is to declare that there are no sources of funding and none of the authors have any conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Min-Hoe Chew, Peter J. M. Lee, Cherry E. Koh & Hwee E. Chew

  2. Surgical Outcome Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Suite 415, RPAH Medical Centre Suite, 100 Carillon Avenue, Newtown 2042, Sydney, NSW, Australia

    Min-Hoe Chew, Peter J. M. Lee, Cherry E. Koh & Hwee E. Chew

  3. Suite 415, RPAH Medical Centre Suite, 100 Carillon Avenue, Newtown 2042, Sydney, NSW, Australia

    Peter J. M. Lee

Authors
  1. Min-Hoe Chew
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  2. Peter J. M. Lee
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  3. Cherry E. Koh
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  4. Hwee E. Chew
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Correspondence to Peter J. M. Lee.

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This is to confirm that all the authors listed above have been involved in the contributions to the paper in the study design, data acquisition, analysis and interpretation of data; drafting the article as well as revising and final approval of the version to be published.

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Chew, MH., Lee, P.J.M., Koh, C.E. et al. Appraisal of the LIFT and BIOLIFT procedure: initial experience and short-term outcomes of 33 consecutive patients. Int J Colorectal Dis 28, 1489–1496 (2013). https://doi.org/10.1007/s00384-013-1702-0

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  • DOI: https://doi.org/10.1007/s00384-013-1702-0

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