Sileri P, Franceschilli L, Angelucci GP, et al. Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study
ABSTRACT Ligation of the intersphincteric tract (LIFT), a novel sphincter-saving technique, has been recently described with promising results. Literature data are still scant. In this prospective observational study, we present our experience with this technique.
Between October 2010 and April 2011, 18 patients with 'complex' fistulas underwent LIFT. All patients were enrolled in the study after a physical examination including digital examination and proctoscopy. For the purpose of this pilot study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula or pre-existing incontinence. Endpoints were healing time, presence of recurrence, faecal incontinence and surgical complications.
Ten patients were men and 8 were women; mean age was 39 years; minimum follow-up was 4 months. Three patients required drainage seton insertion and delayed LIFT. After LIFT, 1 patient experienced haemorrhoidal thrombosis. At the end of the follow-up, 15 patients (83%) healed with no recurrence. Three patients had persistent symptoms and required further surgical treatment. We did not observe postoperative worsening of continence.
Results from our pilot study indicate that this novel sphincter-saving approach is effective and safe for treating complex anal fistula.
- SourceAvailable from: Martijn Pieter Gosselink
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- "Though the effect of epithelialization on fistula healing was not assessed, the authors stated that epithelialization might contribute to the persistence of fistulas. This hypothesis is still generally accepted, despite the lack of evidence [17, 18]. Recently, Van Koperen et al.  examined the presence of epithelium in fistula tracts. "
ABSTRACT: At present, transanal advancement flap repair (TAFR) is the treatment of choice for transsphincteric fistulas passing through the upper and middle third of the external anal sphincter. It has been suggested that epithelialization of the fistula tract contributes to the failure of the treatment. The aim of this study was to assess the prevalence of epithelialization of the fistula tract and to study its effect on the outcome of TAFR and TAFR combined with ligation of the intersphincteric fistula tract (LIFT). Forty-four patients with a high transsphincteric fistula of cryptoglandular origin underwent TAFR. Nine of these patients underwent a combined procedure of TAFR with LIFT. In all patients the fistula tract was excised from the external opening up to the outer border of the external anal sphincter. In patients undergoing TAFR combined with LIFT an additional central part of the intersphincteric fistula tract was excised. A total of 53 specimens were submitted. Histopathological examination of the specimens was carried out by a pathologist, blinded for clinical data. Epithelialization of the distal and intersphincteric fistula tract was observed in only 25 and 22% of fistulas, respectively. There was no difference in outcome between fistulas with or without epithelialization. Epithelialization of high transsphincteric fistulas is rare and does not affect the outcome of TAFR and TAFR combined with LIFT.Techniques in Coloproctology 01/2012; 16(2):113-7. DOI:10.1007/s10151-011-0803-4 · 1.34 Impact Factor
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ABSTRACT: La technique de ligature élective du trajet fistuleux dans le traitement de la fistule anale transsphinctérienne haute est une approche mini-invasive d’épargne sphinctérienne actuellement en évaluation. La technique est décrite point par point ainsi que les résultats publiés dans la littérature. Cette intervention pourrait prendre une place croissante dans le traitement de ces affections difficiles à guérir.Côlon & Rectum 05/2012; 6(2). DOI:10.1007/s11725-012-0365-2
Article: Controversies in fistula in ano.[Show abstract] [Hide abstract]
ABSTRACT: Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications-recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.Indian Journal of Surgery 06/2012; 74(3):217-20. DOI:10.1007/s12262-012-0594-5 · 0.27 Impact Factor