Assessment of LIFT (ligation of the intersphincteric fistula tract) technique in patients with perianal transsphincteric fistulas / Avaliação da técnica LIFT (ligation of the intersphincteric fistula tract) em pacientes com fístulas perianais transesfincterianas

Perianal fistulas are a relatively common condition in Proctology offices, ranging from simple cases with easily palpable superficial tracts to complex problems with deep tracts across significant portions of the anal sphincter, which section can lead to varying degrees of incontinence during a fistulotomy. Objective: To evaluate the effectiveness of the use of the LIFT (ligation of the intersphincteric fistula tract) technique in patients with perianal transsphincteric fistulas. Method: A prospective study of patients with perianal transsphincteric fistula who underwent LIFT. Patients with perianal fistulas of cryptoglandular transsphincteric origin with no previous surgical interventions were included in the study. Patients with perianal fistulas from another source, such as Crohn's disease, tuberculosis, anal cancer and recurrent fistulas, were excluded. All patients underwent the same anesthetic technique, with subsequent surgical treatment in two stages: seton placement and, after 6 weeks, completion of LIFT. Results: We evaluated 22 patients; the mean age was 45.6 years. The post-LIFT outpatient follow-up ranged from 4 to 24 months with a mean follow-up of 14 months. The healing time varied from 4 to 8 weeks after the procedure. Seventeen patients were cured (77%) and five relapsed (23%); however, all of them exhibited the intersphincteric type, having been treated by fistulotomy and also achieving complete cure. One female patient developed mild fecal incontinence. Conclusion: The LIFT technique proved to be safe and effective in the treatment of transsphincteric perianal fistulas. (AU)

As fístulas perianais são uma condição relativamente comum em consultório de proctologia, podendo variar desde casos simples, com trajetos superficiais facilmente palpáveis, até casos complexos, com trajetos profundos, atravessando porções consideráveis do apar-elho esfincteriano, cuja secção pode levar a graus variáveis de incontinência durante uma fistulotomia. Objetivo: Avaliar a efetividade do emprego da técnica LIFT (ligation of the intersphincteric fistula tract) nos pacientes portadores de fístulas perianais transesfincterianas. Método: Estudo prospectivo com pacientes portadores de fístula perianal transesfincteri-ana submetidos à técnica LIFT. Foram incluídos no estudo pacientes portadores de fistulas perianais de origem criptoglandular transesfincteriana sem intervenções cirúrgicas prévias. Foram excluídos pacientes portadores de fístulas perianais de outra origem, como doença de Crohn, tuberculose, neoplasia anal e fístulas recidivadas. Todos os pacientes foram submetidos à mesma técnica anestésica e posterior tratamento cirúrgico em dois tempos: colocação de sedenho e após seis semanas realização de LIFT. Resultados: Foram avaliados 22 pacientes; a média de idade observada foi de 45,6 anos. O seguimento ambulatorial pós-LIFT variou de 4 a 24 meses, com média de acompanhamento de 14 meses. O tempo de cicatrização variou de 4 a 8 semanas pós-procedimento. Dezessete pacientes ficaram curados (77%) e cinco apresentaram recidiva (23%), porém, todos na forma interesfincteriana e foram tratados por fistulotomia, alcançando também a cura completa. Uma paciente evoluiu com incontinência fecal leve. Conclusão: A técnica LIFT demonstrou ser segura e eficaz no tratamento das fístulas perianais transesfincterianas. (AU)

Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results / Eficácia da técnica de ligadura interesfincteriana do trato fistuloso (LIFT) no tratamento da fístula anal: resultados iniciais

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence. .

RACIONAL: Os abscessos e fístulas anais representam cerca de 70% do total das supurações perianais, estimando-se incidência de 1/10000 habitantes por ano e representando 5% das consultas em coloproctologia. OBJETIVO: Avaliar a eficácia da técnica de ligadura interesfincteriana do trato fistuloso no tratamento de fístula anal. MÉTODOS: Foram estudados os prontuários de oito pacientes submetidos à essa técnica avaliando-se idade, sexo e presença de incontinência. Denominou-se primeiro tempo da técnica a passagem de sedenho com fio de algodão zero a fim da correta individualização do trajeto fistuloso e, como segundo tempo a realização do procedimento. RESULTADOS: Dois pacientes eram homens e oito mulheres. A média de idade foi de 42,8 anos. Desse total, sete (87,5%) evoluíram com cura completa da fístula, seis somente com esse procedimento e um necessitou passar por operação adicional após a realização do segundo tempo, com fistulotomia simples. Apenas uma paciente evoluiu com incontinência fecal a qual foi documentada por exame de manometria anorretal. Não houve óbitos nessa série. CONCLUSÃO: A técnica de ligadura interesfincteriana do trato fistuloso mostrou-se eficaz para o tratamento da fístula anal e não deve ser desestimulada a despeito da ocorrência de incontinência fecal. .

Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results.

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence.