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Increasing experience with the LIFT procedure in Crohn’s disease patients with complex anal fistula

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Abstract

Background

Surgical management of anal fistulas in Crohn’s disease (CD) is associated with high failure rates, and treatment options are limited due to ongoing proctitis, multiple tracts, and concern for incontinence and non-healing wounds. The aim of this study was to investigate the healing rate of ligation of the inters-sphincteric fistula tract (LIFT) for anal fistulas in Crohn’s disease and identify prognostic factors for healing.

Methods

This prospective analysis compared long-term healing rates of CD patients undergoing LIFT for anal fistulas. Consecutive patients with CD who underwent LIFT procedure at our institution, in the period from March 2012 to September 2019 were included. The main outcome was anal fistula healing rate.

Results

The study cohort of 46 patients (mean age of 34.2 ± 13.0 years, 18 (40%) males). After a mean follow-up time of 33 ± 28 months, fistula healing was seen in 30 (65%) patients. A total of 8 patients were noted to have inter-sphincteric recurrence and 8 patients had trans-sphincteric recurrence. Smoking at the time of surgery was significantly associated with LIFT failure (HR 3.18, 95% CI 1.18–8.61, p = 0.02). Other factors, such as age, sex, race, disease duration and location, type of fistula history of proctitis, preoperatively use of biologics or a seton, and previous repair attempts, did not appear to influence LIFT healing. Although not statistically significant, there was a trend toward increase in failure among patients with active proctitis at the time of surgery (HR 1.97, 95% CI 0.71–5.42, p = 0.19).

Conclusion

Our increasing experience with LIFT for anal fistula in CD demonstrates a higher rate of healing (65%) than previously reported (48%). Smoking appears to negatively influence healing of LIFT in CD.

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References

  1. Schwartz DA, Loftus EV Jr, Tremaine WJ et al (2002) The natural history of fistulizing Crohn’s disease in Olmsted County. Minn Gastroenterol 122:875–880

    Article  Google Scholar 

  2. Schwartz DA, Herdman CR (2004) Review article: the medical treatment of Crohn’s perianal fistulas. Aliment Pharmacol Ther 19:953–967

    Article  CAS  Google Scholar 

  3. Williamson PR, Hellinger MD, Larach SW et al (1995) Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum 38:389–392

    Article  CAS  Google Scholar 

  4. Present DH, Rutgeerts P, Targan S et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340(18):1398–1405

    Article  CAS  Google Scholar 

  5. Bouguen G, Siproudhis L, Gizard E et al (2013) Long-term outcome of perianal fistulizing Crohn’s disease treated with infliximab. Clin Gastroenterol Hepatol 11(8):975-81.e1–4

    Article  CAS  Google Scholar 

  6. Grimaud JC, Munoz-Bongrand N, Siproudhis L et al (2010) Fibrin glue is effective healing perianal fistulas in patients with Crohn’s disease. Gastroenterology 138:2275–2281

    Article  CAS  Google Scholar 

  7. O’Riordan JM, Datta I, Johnston C et al (2012) A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum 55:351–358

    Article  Google Scholar 

  8. 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 

  9. 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  Google Scholar 

  10. 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  Google Scholar 

  11. 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  CAS  Google Scholar 

  12. 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  Google Scholar 

  13. Tan K, Tan IJ, Lim FS et al (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  Google Scholar 

  14. Mushaya C, Bartlett L, Schulze B et al (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  Google Scholar 

  15. Gingold CS, Murrell ZA, Fleshner PR (2014) A prospective evaluation of the ligation of the intersphincteric tract procedure for complex anal fistula in patients with Crohn’s disease. Ann Surg 260:1057–1061

    Article  Google Scholar 

  16. Kaminski JP, Zaghiyan K, Fleshner PR (2017) Increasing experience of ligation of the intersphincteric fistula tract for patients with Crohn’s disease: what have we learned? Colorectal Dis 19:750–755

    Article  CAS  Google Scholar 

  17. van Pragg EM, Stellingwerf ME, van der Bilt JD et al (2020) Ligation of the intersphincteric fistula tract and endorectal advancement flap for high perianal fistulas in Crohn’s disease: a retrospective cohort study. J Crohns Colitis 14(6):757–763

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  19. Mizrahi N, Wexner SD, Zmora O et al (2002) Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum 45(12):1616–1621

    Article  Google Scholar 

  20. Makowiec F, Jehle EC, Becker HD, Starlinger M (1995) Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn’s disease. Br J Surg 82(5):603–606

    Article  CAS  Google Scholar 

  21. Joo JS, Weiss EG, Nogueras JJ, Wexner SD (1998) Endorectal advancement flap in perianal Crohn’s disease. Am Surg 64(2):147–150

    CAS  PubMed  Google Scholar 

  22. Mujukian A, Truong A, Fleshner P, Zaghiyan K (2020) Long-term healing after complex anal fstula repair in patients with Crohn’s disease. Tech Coloproctol 24:833–841

    Article  CAS  Google Scholar 

  23. Smith BR, Arnott ID, Drummond HE et al (2004) Disease location, anti-Saccharomyces cerevisiae antibody, and NOD2/CARD15 genotype influence the progression of disease behavior in Crohn’s disease. Inflamm Bowel Dis 10:521–528

    Article  Google Scholar 

  24. Aldhous MC, Drummond HE, Anderson N et al (2007) Does cigarette smoking influence the phenotype of Crohn’s disease? Analysis using the Montreal classification. Am J Gastroenterol 102:577–588

    Article  Google Scholar 

  25. Zimmerman DD, Delemarre JB, Gosselink MP et al (2003) Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas. Br J Surg 90:351–354

    Article  CAS  Google Scholar 

  26. El-Gazzaz G, Hull T, Mignanelli E et al (2010) Analysis of function and predictors of failure in women undergoing repair of Crohn’s related rectovaginal fistula. J Gastrointest Surg 14:824–829

    Article  Google Scholar 

  27. Atia O, Asayag N, Focht G, et al (2021) Perianal Crohn’s disease is associated with poor disease outcome: a nation-wide study from the epiIIRN cohort. Clin Gastroenterol Hepatol. https://doi.org/10.1093/ecco-jcc/jjab204

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Cedars-Sinai Medical Center, 8737 Beverly Blvd, Suite 101, Los Angeles, CA, 90048, USA

    T. Wood, A. Truong, A. Mujukian, K. Zaghiyan & P. Fleshner

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  1. T. Wood
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  2. A. Truong
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  3. A. Mujukian
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  4. K. Zaghiyan
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  5. P. Fleshner
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by TW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to P. Fleshner.

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The authors declare that they have no conflict of interest.

Ethics approval

All research-related activities were approved by the Cedars-Sinai Medical Center Institutional Review Board (IRB # 29837).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data.

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Wood, T., Truong, A., Mujukian, A. et al. Increasing experience with the LIFT procedure in Crohn’s disease patients with complex anal fistula. Tech Coloproctol 26, 205–212 (2022). https://doi.org/10.1007/s10151-022-02582-4

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  • DOI: https://doi.org/10.1007/s10151-022-02582-4

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