Effectiveness of ligation of intersphincteric fistula tract (LIFT) in the management of fistulas in ano

Dushyant Kumar Rohit; Sarvesh Jain; Grishmraj Pandey

doi:10.18203/2349-2902.isj20175158

Authors

Dushyant Kumar Rohit Department of Surgery, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
Sarvesh Jain Department of Anaesthesia, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
Grishmraj Pandey Student, Bundelkhand Medical College, Sagar, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175158

Keywords:

Fistula in ano, Fistula tract, Fistulotomy, Incontinence, LIFT technique

Abstract

Background: Fistula in ano is an abnormal connection between the epithelized surface of anal canal and usually the perianal skin. It is a benign treatable lesion of rectum and anal canal. Crypto glandular infection accounts for about ninety percent of the cases. The estimated prevalence of an anal fistula is 12 to 28/1000000 of the population per year with male to female ratio 1.8:1. Ligation of intersphincteric fistula tract is a new sphincter saving method with good result in the management of anal fistula. The aim of study was to evaluate the effectiveness and functional outcomes of the ligation of intersphinteric fistula tract (LIFT).

Methods: This prospective study includes sixteen patients who were operated for fistulas in ano at Bundelkhand Medical College and Associated Hospital, Sagar from January 2015 to June 2017. Patients above the age of 20 years, proved cases of fistulas in ano without co-morbid conditions and no previous surgical intervention were included in the study. Patients presenting with fistulas from another source such as crohn’s disease, tuberculosis, anal cancer and recurrent fistulas were excluded. A detailed history, clinical presentation, digital rectal examination, anal ultrasound and routine investigations were done in all cases.

Results: In the present study most of the patients were male and presents with perianal discharge. The diagnosis is made by clinical history, per rectal examination and anal ultrasonography. All the sixteen patients with fistula in ano underwent ligation of intersphincteric fistula tract (LIFT). The patients were followed for a period of three months. Most of the cases (87.5%) healed within 4-6 weeks. The recurrence of fistula occurs in four cases (25%). Recurrence is due to infection and technical error in the procedures. There were no deaths in the study.

Conclusions: The LIFT technique proved to be safe and effective in the treatment of fistula in ano.

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References

Malik A, Nelson R. Surgical management of anal fistulae: a systematic review. Colorectal Dis. 2008;10(5);420-30.

Ortiz H, Marzo J, Ciga MA, Oteiza F, Armendáriz P, De Miguel M. Randomized clinical trial of anal fistula plugs versus Endorectal advancement flap for the treatment of crypto glandular fistula in ano. Br J Surg. 2009;96(6):608-12.

Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D. An assessment of the incidence of fistula in ano in four countries of the European Union. Int J Colorectal Dis. 2007;22:1459-62.

Davies M, Harris D, Lohana P, Sekaran TC, Morgan AR, Beynon J et al. The surgical management of fistula in ano a specialist colorectal unit. Int J Colorectal Dis. 2008;23(9):833-8.

Parks AG, Gordon PH, Hardcastle JD. A classification of fistula in ano. Br J Surg. 1976;63;1-12.

Mizrahi N, Wexner HD, Zmora O, DaSilva G, Efron J, Weiss EG et al. Endorectal advancement flap: Are there predictors of failure? Dis Colon Rectum. 2002;45:1616-21.

Bleier JI, Moloo H, Goldberg SM. Ligation of inter sphincteric fistula tract. Dis Colon Rectum. 2010;53:43-6.

Vasilersky CA, Gordon PH. The incidence of recurrent abscesses or fistula in ano following anorectal suppuration. Dis Colon Rectum. 1984;27:126-30.

Van Tets WF, Kuizers HE. Continence disorder after anal fistulotomy. Dis Colon Rectum. 1994;37:1194-7.

Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM. Seton treatment of high anal fistulae. Br J Surg. 1991;78:1159-61.

Van Tets WF, Kuijpers JH. Seton treatment of fistula with high anal or rectal opening. Br J Surg. 1995;82:895-7.

Kodner IJ, Mazor A, Shemesh EI, Fry RD, Fleshman JW, Birnbaum EH. Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas. Surg. 1993;114:682-9.

Kreis ME, Jehle EC, Ohlemann M, Becker HD, Starlinger MJ. Functional results after trans anal rectal advancement flap repair of trans sphincteric fistula. Br J Surg. 1998;85:240-2.

Zimmerman DD, Briel JW, Gosselink MP, Schouten WR. Ano cutaneous advancement flap repair of trans sphincteric fistula. Dis Colon Rectum. 2001;44:1474-80.

Cintron JR, Park JJ, Orsay CP, Nelson RL, Sone JH et al. Repair of fistula in ano using fibrin adhesive; Long term follow up. Dis Colon Rectum. 2000;43:944-9.

Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. Fibrin glue in closure of anorectal fistula. Dis Colon Rectum. 2006;49:371-6.

Rojanasakul A, Pattanaarum J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula in ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007 Mar;90(3):581-6.

Toyonaga T, Matsushima M, Tanaka Y, Suzuki K, Sogawa N, Kanyama H, et al. Non-sphincter splitting fistulectomy conventional fistulotomy for high trans sphincteric fistula in ano: a prospective functional and manometric study. Int J Colorectal Dis. 2007;22(9):100-2.

Murugesan J, Mor I, Fulham S, Hitos K. Systematic review of efficacy of LIFT procedure in crypto glandular fistula in ano. J Coloproctol. 2014;34(2):109-19.

Hussain K, Qureshi MK MHAS, Ahmed N, Tipu SA. Management of fistula in ano. J Physicians Surg Pak. 2002;12:361-3.

Ahmad SRN, Mahmoud T. Use of seton in complicated anal fistula: A study at Sindh Govt. Qatar Hospital, Karachi. Pak J Surg. 2003;19(1):25-9.

Buchanan G, Owen H, Torkington J, Lunniss P, Nichol Cohen C. Long term outcome following loose sphincter technique for external sphincter preservation in complex fistula. Br J Surg. 2004;91(4):476-80.

Takayuki TYT, Matsushima M. Evidence based treatment strategy for ano rectal sepsis and fistula. Nippon Daicho Komonbyo Gakkai Zasshi. 2009;(7):364-377.

Sainio P, Husa A. Fistula in ano. Clinical features and Long-term results of surgery in 199 adults. Acta Chiru Scandinavica. 1984;151(2):169-76.

Huda T, Ashok M. LIFT technique for fistula in ano with redefined criteria: A step towards better outcome. IOSR J. 2013;11(1):61-3.

Sileri P, Franceschilli L, Angelucci GP, D’Ugo S, Milito G, Cadeddu F, et al. Ligation of the inter sphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study. Tech Coloprotol. 2011;15(4):413-6.

Makhlouf G, Korany M. LIFT technique for fistula in ano. Egyptian J Surg. 2013 Jan;32(1):32-3.