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Management of complex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT)

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Abstract

Background

Ligation of intersphincteric fistula tract (LIFT) is a relatively new technique in the treatment of complex anorectal fistulas. As it spares the anal sphincter, rates of post-operative incontinence may be lower when compared to conventional treatment. To date, there have not been enough reports of long-term fistula recurrence rates. We performed a long-term follow-up study of 75 patients who underwent LIFT following seton drainage and partial fistulotomy.

Methods

Only patients with complex cryptogenic anorectal fistulas were included. After seton insertion and partial fistulotomy, the tract was reviewed at 4 months for the absence of anorectal sepsis. Patients then underwent LIFT in a day surgery setting. Operative time, complications, recurrences and incontinence were evaluated.

Results

Between May 2008 and June 2013, 75 patients [51 men, mean age 49.5 years, standard error of the mean (SEM) 1.4 years] were treated with a LIFT protocol. The mean operating time for LIFT was 13.2 min (SEM 1.5 min). Complications included minor bleeding, superficial wound dehiscence and perianal pain. At a mean follow-up of 14.6 months (SEM 1.7 months), there were nine (12 %) recurrences, diagnosed at a mean 9.2 months (SEM 2.7 months). They were treated with seton insertion followed by LIFT with biomesh or anorectal advancement flap, and there were no subsequent recurrences. Review of preoperative and post-operative continence scores revealed only one (1.3 %) patient with minor incontinence following LIFT. Recurrences were significantly related to fistulas with multiple tracts (p < 0.001).

Conclusions

Our results suggest that the protocol of seton insertion and partial fistulotomy followed by LIFT is associated with a low recurrence rate comparing well with published results from studies involving other techniques and protocols for treating anal fistula.

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References

  1. Song KH (2012) New techniques for treating an anal fistula. J Korean Soc Coloproctol 28:7–12

    Article  PubMed Central  PubMed  Google Scholar 

  2. Whiteford MH, Kilkenny J, Hyman N (2005) Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum 48:1337–1342

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Ho YH, Tan M, Leong AF, Seow-Choen F (1998) Marsupialization of fistulotomy wounds improves healing: a randomised controlled trial. Br J Surg 85:105–107

    Article  CAS  PubMed  Google Scholar 

  5. Vasilevsky CA, Gordon PH (1984) The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27:126–130

    Article  CAS  PubMed  Google Scholar 

  6. Theerapol A, So BY, Ngoi SS (2002) Routine use of setons for the treatment of anal fistulae. Singap Med J 43:305–307

    CAS  Google Scholar 

  7. Cintron JR, Park JJ, Orsay CP et al (2000) Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up. Dis Colon Rectum 43:944–999

    Article  CAS  PubMed  Google Scholar 

  8. Sentovich SM (2003) Fibrin glue for anal fistulas: long-term results. Dis Colon Rectum 46:498–502

    Article  PubMed  Google Scholar 

  9. Maralcan G, Başkonuş I, Gökalp A, Borazan E, Balk A (2011) Long-term results in the treatment of fistula-in-ano with fibrin glue: a prospective study. J Korean Surg Soc 81:169–175

    Article  PubMed Central  PubMed  Google Scholar 

  10. Buchanan GN, Bartram CI, Phillips RK et al (2003) Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum 46:1167–1174

    Article  PubMed  Google Scholar 

  11. McGee MF, Champagne BJ, Stulberg JJ, Reynolds H, Marderstein E, Delaney CP (2010) Tract length predicts successful closure with anal fistula plug in cryptoglandular fistulas. Dis Colon Rectum 53:1116–1120

    Article  PubMed  Google Scholar 

  12. Schwandner T, Roblick MH, Kierer W, Brom A, Padberg W, Hirschburger M (2009) Surgical treatment of complex anal fistulas with the anal fistula plug: a prospective, multicenter study. Dis Colon Rectum 52:1578–1583

    Article  PubMed  Google Scholar 

  13. Champagne BJ, O’Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN (2006) Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum 49:1817–1821

    Article  PubMed  Google Scholar 

  14. Ozuner G, Hull TL, Cartmill J et al (1996) Long-term analysis of the use of transanal rectal advancement flaps for the complicated anorectal/vaginal fistulas. Dis Colon Rectum 39:10–14

    Article  CAS  PubMed  Google Scholar 

  15. Jarrar A, Church J (2011) Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum 54:1537–1541

    Article  PubMed  Google Scholar 

  16. Ho KS, Ho YH (2005) Controlled, randomised trial of island flap anoplasty for treatment of trans-sphincteric fistula-in-ano: early results. Tech Coloproctol 9:166–168

    Article  CAS  PubMed  Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. 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 54:1368–1372

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  21. 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 

  22. Ooi K, Skinner I, Croxford M, Faragher I, McLaughlin S (2011) Managing fistula-in-ano with ligation of intersphincteric fistula tract procedure: the Western Hospital experience. Colorectal Dis 14:599–603

    Article  Google Scholar 

  23. 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 15:413–416

    Article  CAS  PubMed  Google Scholar 

  24. Abcarian AM, Estrada JJ, Park J et al (2012) Ligation of intersphincteric fistula tract: early results of a pilot study. Dis Colon Rectum 55:778–782

    Article  PubMed  Google Scholar 

  25. Mushaya C, Bartlett L, Schulze B, Ho YH (2012) Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage. Am J Surg 204:283–289

    Article  PubMed  Google Scholar 

  26. Tan KK, Alsuwaigh R, Tan AM et al (2012) To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula? Dis Colon Rectum 55:1273–1277

    Article  PubMed  Google Scholar 

  27. Wallin UG, Mellgren AF, Madoff RD, Goldberg SM (2012) Does ligation of intersphincteric fistula tract raise the bar in fistula surgery? Dis Colon Rectum 55:1173–1178

    Article  PubMed  Google Scholar 

  28. Campbell M, Abboud EC, Dolberg ME, Sanchez JE, Marcet JE, Rasheid SH (2013) Treatment of refractory perianal fistulas with ligation of the intersphincteric fistula tract: preliminary results. Am Surg 79:723–727

    PubMed  Google Scholar 

  29. Lehmann JP, Graf W (2013) Efficacy of LIFT for recurrent anal fistula. Colorectal Dis 15:592–595

    Article  PubMed  Google Scholar 

  30. Liu WY, Aboulian A, Kaji AH, Kumar RR (2013) Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum 56:343–347

    Article  PubMed  Google Scholar 

  31. Tsunoda A, Sada H, Sugimoto T, Nagata H, Kano N (2013) Anal function after ligation of the intersphincteric fistula tract. Dis Colon Rectum 56:898–902

    Article  PubMed  Google Scholar 

  32. Alsari S, Kim NK (2013) Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT). Tech Coloproctol 18:13–22

    Article  Google Scholar 

  33. Yassin NA, Hammond TM, Lunniss PJ, Phillips RKS (2013) Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Dis 15:527–535

    Article  CAS  PubMed  Google Scholar 

  34. Longo WE, Dean PA, Virgo KS, Vernava AM (1993) Colonoscopy in patients with benign anorectal disease. Dis Colon Rectum 36:368–371

    Article  CAS  PubMed  Google Scholar 

  35. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  36. Maier AG, Funovics MA, Kreuzer SH et al (2001) Evaluation of perianal sepsis: comparison of anal ultrasonography and magnetic resonance imaging. J Magn Reson Imaging 14:254–260

    Article  CAS  PubMed  Google Scholar 

  37. Joyce M, Veniero JC, Kiran RP (2008) Magnetic Resonance Imaging in the Management of Anal Fistula and Anorectal Sepsis. Clin Colon Rectal Surg 21:213–219

    Article  PubMed Central  PubMed  Google Scholar 

  38. Blumetti J, Abcarian A, Quinteros F, Chaudhry V, Prasad L, Abcarian H (2012) Evolution of treatment of fistula in ano. World J Surg 36:1162–1167

    Article  CAS  PubMed  Google Scholar 

  39. Corman ML (2008) The surgisis AFP anal fistula plug: report of a consensus conference. Colorectal Dis 10:17–20

    Google Scholar 

  40. Van Onkelen RS, Gosselink MP, Schouten WR (2012) Ligation of intersphincteric fistula tract in low transsphincteric fistulae: a new technique to avoid fistulotomy. Colorectal Dis 15:587–591

    Article  Google Scholar 

  41. Van Onkelen RS, Gosslink MP, Schouten WR (2012) Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric tract? Dis Colon Rectum 55:163–166

    Article  PubMed  Google Scholar 

  42. Han JG, Yi BQ, Wang ZJ et al (2012) Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano. Colorectal Dis 15:582–586

    Article  Google Scholar 

  43. Tan KK, Lee PJ (2013) Early experience of reinforcing the ligation of the intersphincteric fistula tract procedure with a bioprosthetic graft (BioLIFT) for anal fistula. ANZ J Surg 84:280–283

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  45. Hong KD, Kang S, Kalaskar S, Wexner SD (2014) Ligation of interspincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol 18:685–691

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Townsville Hospital, Townsville, QLD, 4814, Australia

    B. Schulze

  2. Department of Surgery, School of Medicine and the Australian Institute of Tropical Medicine, James Cook University, Townsville, QLD, 4814, Australia

    Y.-H. Ho

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  1. B. Schulze
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Correspondence to B. Schulze.

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Schulze, B., Ho, YH. Management of complex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT). Tech Coloproctol 19, 89–95 (2015). https://doi.org/10.1007/s10151-014-1245-6

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  • DOI: https://doi.org/10.1007/s10151-014-1245-6

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