ABSTRACT
ABSTRACT Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.
RESUMO Racional: É importante, mas difícil de se tratar fístula anal complexa devido à alta taxa de recorrência e de incontinência pós-operatória. A ligadura do trajeto da fístula interesfincteriana (LIFT) - um novo procedimento cirúrgico com a vantagem de evitar a incontinência anal - tem taxa de sucesso variável entre 57-94,4%. Objetivo: Avaliar os resultados em longo prazo do procedimento cirúrgico LIFT modificado - ligadura do trato interesfincteriano com fístula - para tratar fístula complexa anal. Métodos: Análise retrospectiva de 62 casos de fístula complexa no ânus tratados com abordagem modificada de LIFT (incisão curva na pele do canal anal; sutura em bolsa realizada em torno da fístula; as fístulas residuais removidas em um túnel) e teve tempo de acompanhamento de mais de um ano. A condição geral pré-operatória dos pacientes, a eficácia pós-operatória e a função anal foram comparadas. Resultados: A mediana de idade dos participantes foi de 34 anos, e 43 (69,4%) dos casos eram de homens. Quarenta e um (66,1%) casos eram de fístula transesfincteriana alta, quatro (6,5%) de fístula intra-esfincteriana alta e 17 (27,4%) de fístula anal anterior em mulheres. A mediana da duração do acompanhamento foi de 24,5 meses (12-51). A taxa de sucesso no final do acompanhamento foi de 83,9% (52/62). A pressão anorretal e a Incontinência Fecal da Cleveland Clinic Florida (CCF-FI) avaliadas três meses antes e após a operação não encontraram alterações aparentes. Conclusões: Comparado com o LIFT, o LIFT modificado reduz notavelmente a falha pós-operatória e a taxa de recorrência de fístula complexa com resultados aceitáveis em longo prazo.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anal Canal/abnormalities , Anal Canal/surgery , Rectal Fistula/surgery , Ligation/methods , Anal Canal/physiopathology , Retrospective Studies , Follow-Up Studies , Suture Techniques , Rectal Fistula/physiopathology , Treatment Outcome , Fecal Incontinence/surgery , Surgical Wound , Medical IllustrationABSTRACT
Objective To study the effects of modified ligation of intersphincteric fistula tract (LITF)for low anal fistula.Methods A total of 40 consecutives were divided randomly into experiment and control groups(each 20 cases).The patients in experiment group received modified LITF and patients in control group adopted traditional anal fistula resection,then to compare the effects.Results The wound healing time in experiment group[(17.8 ± 4.5)d]was shorter than that in control group[(24.7 ± 5.8) d](P<0.05);the duration of pain in experiment group[(6.9 ± 1.5)d]was longer than that in control group[(4.0 ± 1.3)d](P<0.05);the postoperative anal function score in experiment group(3.7 ± 2.5)was better than that in control group(3.7 ± 2.5)(P<0.05).There were no significant differences in cure rate,pain at first day after operation and recurrence rate between two groups(P>0.05).Conclu-sion It is more effective,less injury,less pain,shorter course,less recurrence and better anal function of modified LITF.
ABSTRACT
Objective To evaluate the clinical effects of modified ligation of the fistula tract (LIFT)in the treatment of simple transsphincteric anal fistula.Methods 92 patients with a clinical diag-nosis of simple transsphincteric anal fistula were enrolled into the research.According to the random num-ber table patients divided into the modified group(46 cases)and the normal group(46 cases)randomly. Operation time,postoperative pain score,postoperative hospitalization time,healing time and healing rate in two groups were compared,Wexner anal incontinence scores and anorectal manometry 3 months after operation were analyzed to evaluated anal function.Results All patients were followed up for 3 ~26 months,average(8.73 ± 7.15)months.Comparing with operation time,hospitalization time,postoperative pain score 24 h after operation,hospital stay had no significantly different between the two groups(all P>0.05).The healing time had significantly different between the modified group[(10.14 ± 2.57)d]with the normal group[(23.87 ± 4.68)d](P<0.05);The healing rate in modified group was(91.2%)sig-nificantly higher thanin normal group(71.7%)(P<0.05).By the Wexner anal incontinence scores and anorectal manometry 3 months after operation were not significantly different(P>0.05).Conclusion Modified LIFT is a safe technique with a high healing rate and a shorter healing time,in the treatment of simple transsphincteric anal fistula,modified LIFT procedures should be considered.
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Objective To assess the efficacy and safety of modified ligation of the intersphincteric fistula tract (LIFT) for low anal fistula.Methods We follow-up visited 20 patients with low anal fistula underwent modified LIFT procedures (Since the outer edge shape of anal fistula incision fistula and the branch into the intersphincteric groove,proximal lateral internal sphincterotomy ligation.The wound was closed to the whole layer of closed suture after removal of the pipe wall).Median follow-up duration was 10(range 3-15) months.To compile statistics on the wound healing time,the clinical healing rate,the recurrence rate and the fecal incontinence score (Wexner score) of those patients.Results The wound healing time was (15.3 ± 4.8) d.The prime success rate of fistula healing was 75 ％ (15/20) after the modified LIFT procedure.2 cases of low complex anal fistula presented with wound infection,and 3 cases (including 1 cases of simple low anal fistula,2 cases of low complex anal fistula)had fistula with infection.They were cured after appropriate treatment.During follow-up of 3 to 15 (median 10)months,1 cases of simple low anal fistula recurred in third months after surgery.To the end of the follow-up,the total clinical healing rate was 95％ (19/20),of which 12 cases of low complex anal fistula total cure rate was 100％ (12/12).Preoperative fecal incontinence scores (Wexner score)were all 0 points.At the final follow-up,18 (90％)cases of fecal incontinence score were 0 points,1 (5 ％) cases were 2 points and 1 (5 ％) cases were 1 points.Conclusion Modified LIFT is better balance the relationship between cure rate and anal function.The sphincter preservation is complete.The fistula is thoroughly cleared.The cure rate is high.The recurrence rate is low.Does not cause anal defects and deformities.It has little influence on the function of anal control,the operation is simple,and it is suitable to be popularized.
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Objective To evaluate ligation of the intersphincteric fistula tract plus core-out fistulectomy for complex cryptoglandular anal fistulas.Methods Forty-one patients were divided into ligation and control group randomly.In ligation group (20 cases),patients underwent ligation of the intersphincteric fistula tract plus core-out fistulectomy procedure.While in control group (21 cases) fistulotomy on low sphincter with cutting-seton on high sphincter procedure was performed.The primary end points of the study were healing rate and continence by using the Wexner score.Secondary end points were postoperative pain in the third and seventh day with the use of the visual analog scale,length of hospital stay and followed measures for a recurrent fistula.Comparison of measurement data using independent samples t-test or paired samples t-test,compared with the count data using Fisher's exact test.Results There was no statistical difference in the healing rate between ligation group (90％) and control group (95％) (P ＞0.05).Postoperatively,one case in ligation group reported incontinence for gas,compared to 7 cases in control group,among these 7 cases 2 cases also had incontinence for watery stool.Statistical differences were found between two groups in Wexner scores,visual analog scale scores and length of hospital stay (P ＜0.05).Conclusion Ligation of the intersphincteric fistula tract plus core-out fistulectomy is an economical,safe,little painful,recovery enhanced and minimally invasive technique to treat complex anal fistulas.