DOI: http://dx.doi.org/10.18203/2349-2902.isj20205890

A comparative study of Ligation of Intesphincteric Fistula Tract versus conventional fistulectomy in management of low fistula in ano: a randomized control trial

Bhimanagouda V. Goudar, Nawaz M. Dakhani

Abstract


Background: Fistula in ano (FIA) is a chronic complex condition of ano-rectal sepsis characterized by cylical-pain and intermittent chronic purulent discharge. The management of fistula is challenging. In spite of all the advances in the management of FIA, no single method is univresally applicable to all types of FIA due to incontinence and recurrences associated with the individual procedures.

Methods: Aims of this study were to compare the outcomes between ligation of intersphincteric fistula tract (LIFT) and conventional fistulectomy (CF) with 60 patients randomized into 2 groups, 30 in each group.

Results: Mean age in LIFT was 44.17 years and in CF was 41.1 years. Successful primary healing was observed in 86.7% of LIFT and 100% of CF. Mean pain scores were lower in LIFT compared to CF when checked on Postoperative days 1, 3 and 7 significantly. Anal incontinence was seen in 10% of CF and none in LIFT and recurrence was seen at same site in LIFT in 6.66% of LIFT and none in CF both being not statistically significant.

Conclusions: LIFT is a promising and sphincter saving technique which is simple and easy to learn with faster healing rates and better patient contentment but with risk of failure and recurrence. Modifications of LIFT have to be probed for minimizing the failures.


Keywords


Conventional fistulectomy, Fistula in ano, LIFT, Ligation of intersphincteric fistula tract

Full Text:

PDF

References


Shanwani A, Nor AM, Amri N. Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum. 2010;53(1):39-42.

Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465-74.

Parthasarathi R, Gomes RM, Rajapandian S, Sathiamurthy R, Praveenraj P, Senthilnathan P, et al. Ligation of the intersphincteric fistula tract for the treatment of fistula-in-ano: experience of a tertiary care centre in South India. Colorect Dis. 2016;18(5):496-502.

Agarwal A, Bhat SK, Kumar V, Sodhi BS. Clinical presentation and management of anorectal abscess and fistula-in-ano. Int J Scient Stud. 2017;5(5):5.

Shawki S, Wexner SD. Idiopathic fistula-in-ano. World J Gastroenterol. 2011;17(28):3277-85.

Ye F, Tang C, Wang D, Zheng S. Early experience with the modificated approach of ligation of the intersphincteric fistula tract for high transsphincteric fistula. World J Surg. 2015;39(4):1059-65.

Han JG, Wang ZJ, Zheng Y, Chen CW, Wang XQ, Che XM, et al. Ligation of intersphincteric fistula tract versus ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug procedure in patients with transsphincteric anal fistula: early results of a multicenter prospective randomized trial. Ann Surg. 2016;264(6):917-22.

Araújo SEA, Marcante MT, Mendes CRS, Bertoncini AB, Seid VE, Horcel LA, et al. Interesfincterial ligation of fistula tract (lift) for patients with anal fistulas: a brazilian bi-institutional experience. Arq Bras Cir Dig São Paulo. 2017;30(4):235-8.

Ganesan R, Karunakaran K, Anandan H. A comparative study between fistulotomy and fistulectomy in management of low anal fistulae. Int Surg J. 2017;4(11):3665-9.

Emile SH, Elgendy H, Sakr A, Youssef M, Thabet W, Omar W, et al. Gender-based analysis of the characteristics and outcomes of surgery for anal fistula: analysis of more than 560 cases. J Coloproctol. 2018;38(3):199-206.

Aboulian A, Kaji AH, Kumar RR. Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum. 2011;54(3):289-92.

Saber A, Bayumi EK. Perianal abscess; simple drainage versus drainage and fistulotomy. J Surg. 2016;4(3):10.

Pommaret E, Benfredj P, Soudan D, de Parades V. Sphincter-sparing techniques for fistulas-in-ano. J Visc Surg. 2015;152(2 Suppl):S31-6.

Mudakappagol SY, Sunny M. Management of high anal fistula by Kshara Sutra ligation along with partial fistulotomy- a case report. J Indian Syst Med. 2014;2(3):155.

Sirikurnpiboon S, Awapittaya B, Jivapaisarnpong P. Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula. World J Gastrointest Surg. 2013;5(4):123-8.

Sugrue J, Mantilla N, Abcarian A, Kochar K, Marecik S, Chaudhry V, et al. Sphincter-sparing anal fistula repair: are we getting better? Dis Colon Rectum. 2017;60(10):1071-7.

Matos D, Lunniss PJ, Phillips RK. Total sphincter conservation in high fistula in ano: results of a new approach. Br J Surg. 1993;80(6):802-4.

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

Rojanasakul A. LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol. 2009;13(3):237-40.

Arunraj P, Viswanathan MS, Anbazhagan R, Singh K. A prospective interventional study of postoperative pain, healing rates and incontinence rates following ligation of intersphincter fistula tract procedure. Int Surg J. 2018;5(12):3976-81.

Dong X, Jia Z, Yu B, Zhang X, Xu F, Tan L. Effect of intersphincteric fistula tract ligation versus anal fistulectomy on pain scores and serum levels of vascular endothelial growth factor and interleukin-2 in patients with simple anal fistulas. J Int Med Res. 2020;48(9).

Vinay G, Balasubrahmanya KS. Comparative study on efficacy of fistulotomy and ligation of intersphincteric fistula tract (LIFT) procedure in management of fistula-in-ano. Int Surg J. 2017;4(10):3406-8.

Malakorn S, Sammour T, Khomvilai S, Chowchankit I, Gunarasa S, Kanjanasilp P, et al. Ligation of intersphincteric fistula tract for fistula in ano: lessons learned from a decade of experience. Dis Colon Rectum. 2017;60(10):1065-70.

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

Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum. 2013;56(3):343-7.

Galán PC, Lopes C, Múgica JA, Saralegui Y, Borda N, Enríquez Navascués JM. Recurrence/persistence patterns in the LIFT operation for cryptoglandular anal fistula. Long-term observational study. Cir Esp. 2017;95(7):385-90.

Carvalho AL, Alves Filho EF, Alcantara RS, Barreto MD. FILAC-fistula-tract laser closure: a sphincter-preserving procedure for the treatment of complex anal fistulas. J Coloproctol. 2017;37(2):160-2.

Isik O, Gulcu B, Ozturk E. Long-term outcomes of laser ablation of fistula tract for fistula-in-ano: a considerable option in sphincter preservation. Dis Colon Rectum. 2020;63(6):831-6.

Göttgens KWA, Wasowicz DK, Stijns J, Zimmerman D. Ligation of the intersphincteric fistula tract for high transsphincteric fistula yields moderate results at best: is the tide turning? Dis Colon Rectum. 2019;62(10):1231-7.

Khadia M, Muduli IC, Das SK, Mallick SN, Bag L, Pati MR. Management of fistula-in-ano with special reference to ligation of intersphincteric fistula tract. Niger J Surg. 2016;22:1-4.

Lau YC, Brown KGM, Cheong J, Byrne C, Lee PJ. LIFT and BioLIFT: a 10-year single-centre experience of treating complex fistula-in-ano with ligation of intersphincteric fistula tract procedure with or without bio-prosthetic reinforcement (BioLIFT). J Gastrointest Surg. 2020;24(3):671-6.

Madbouly KM, El Shazly W, Abbas KS, Hussein AM. Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum. 2014;57(10):1202-8.

Mushaya C, Bartlett L, Schulze B, Ho YH. Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage. Am J Surg. 2012;204(3):283-9.

Ooi K, Skinner I, Croxford M, Faragher I, McLaughlin S. Managing fistula-in-ano with ligation of the intersphincteric fistula tract procedure: the Western Hospital experience. Colorect Dis. 2012;14(5):599-603.

Sileri P, Giarratano G, Franceschilli L, Limura E, Perrone F, Stazi A, et al. Ligation of the intersphincteric fistula tract (LIFT): a minimally invasive procedure for complex anal fistula: two-year results of a prospective multicentric study. Surg Innov. 2014;21(5):476-80.

Tsunoda A, Sada H, Sugimoto T, Nagata H, Kano N. Anal function after ligation of the intersphincteric fistula tract. Dis Colon Rectum. 2013;56(7):898-902.

Abcarian AM, Estrada JJ, Park J, Corning C, Chaudhry V, Cintron J, et al. Ligation of intersphincteric fistula tract: early results of a pilot study. Dis Colon Rectum. 2012;55(7):778-82.

Tsang JS, Chan TY, Cheung HH, Wei R, Foo CC, Lo OS. Porcine dermal collagen mesh (Permacol™) as a bioprosthesis in the ligation of intersphincteric tract (BioLIFT) procedure. Tech Coloproctol. 2020;24(12):1277-83.

Han JG, Yi BQ, Wang ZJ, Zheng Y, Cui JJ, Yu XQ, et al. Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano. Colorect Dis. 2013;15(5):582-6.

Zwiep TM, Gilbert R, Boushey RP, Schmid S, Moloo H, Raiche I, et al. Comparison of ligation of the intersphincteric fistula tract and BioLIFT for the treatment of transsphincteric anal fistula: a retrospective analysis. Dis Colon Rectum. 2020;63(3):365-70.