Ligation of intersphincteric fistula tract (LIFT) for the treatment of anal fistula: a prospective observational study

Background: The ligation of intersphincteric fistula fract (LIFT) technique avoids postoperative anal continence disturbances and preserves quality of life. Methods: A total of 70 patients with anal fistula (AF) were treated in the Day Surgery Unit. The LIFT technique was the primary treatment in 63 patients. The other had previously undergone placement of a loose seton (two-step approach). The mean follow-up was 66.8 months. Statistical analysis was performed using contingency tables, the chi-square test, and the Student T-test. Results: The use of LIFT was successful in 40 patients (57.1%). However, 6 patients (8.6%) presented persistence of postoperative intersphincteric fistula, being successfully treated by fistulotomy. There were no differences in this technique's success rate between high and low AF (p = 0.45). The success rate of one-step LIFT, however, was significantly higher (p = 0.03). No disturbances of continence were observed. Conclusions: The LIFT technique has a role in the treatment of AF, is suitable for ambulatory surgery, and has a low complications rate. A two-step approach is not always needed. (AU)

Anopexia mucosa grapada para el tratamiento de hemorroides y prolapso mucoso rectal en régimen de cirugía mayor ambulatoria / Stapled mucosal anopexy for the treatment of haemorrhoids and rectal mucose prolapse in day surgery

Introducción: El tratamiento quirúrgico de las hemorroides y del prolapso mucoso rectal mediante anopexia mucosa grapada disminuye el dolor postoperatorio respecto a las técnicas resectivas clásicas. Objetivo: Demostrar que la anopexia mucosa grapada es una técnica segura y efectiva para ser utilizada en cirugía mayor ambulatoria. Pacientes y métodos: Estudio observacional de 327 anopexias mucosa grapada (enero de 2000 a diciembre de 2011) para cirugía hemorroidal. Se evalúa el dolor postoperatorio mediante escala verbal numérica de 0 a 10, los eventos adversos, el grado de satisfacción postoperatoria mediante escala categórica verbal y los resultados del seguimiento (cifra de recidiva global). Asimismo, se analizan los índices principales de cirugía ambulatoria, ingresos no planeados, reingreso y tasa de ambulatorización. Resultados: La edad media de la muestra fue de 48,1 años (rango 21-85). La estancia postoperatoria media en los pacientes ambulatorios fue de 2,25 horas. El índice de ambulatorización fue de 79,8 % (261 pacientes), con un porcentaje de ingresos no planeados de 6,9 % (18 pacientes) y una tasa de reingresos de 1,1 % (3 casos). En cuanto al dolor, el 81,3 % de los pacientes experimentó dolor igual o inferior a 2 y referente a la situación postoperatoria inmediata, el 90 % de los pacientes la expresaron como excelente o buena. La cifra de recidiva global fue del 8,8 % (23 pacientes).Conclusiones: La anopexia mucosa grapada es una técnica segura y efectiva para el tratamiento de las hemorroides en régimen de cirugía sin ingreso. La cifra de recidivas es mayor a la observada con técnicas resectivas. Se puede conseguir una implementación progresiva de esta técnica en régimen ambulatorio con facilidad, con adaptación a los indicadores de calidad (AU)

Background: Stapled mucosal anopexy decreases postoperative pain for the treatment of haemorrhoids and rectal mucose prolapse when comparing with classical resective techniques. Aim of the study: To prove that stapled mucosal anopexy is a save and effective procedure to be performed in ambulatory surgery. Patients and method: From january 2000 to december 2011, 327 stapled mucosal anopexy procedures were performed, 261 cases (79.8 %) were done in ambulatory surgery. The mean age of the series was 48.1 (range 21-85), 165 men and 96 women. Preoperative preparation included phosphate enemas, and antibiotic prophylaxis. Progressive implementation in ambulatory surgery, postoperative pain, admissions, late admissions, early postoperative situation and recurrence were considered for the study. Results: Overall rate for stapled mucosal anopexy for ambulatory surgery was 79.8%. Postoperative pain was measured by a visual analogic scale (1-10), and 81.3 % of the patients expressed pain under 2. Eighteen patients (6.9 %) required admission on the day of surgery and late admission was needed in 3 patients (1.1 %). Ninety per cent of the patients expressed their situation as excellent or good. Overall recurrence of symptoms was 23 cases (8.8 %).Conclusions: Stapled mucosal anopexy is a safe and effective procedure for prolapsing haemorrhoids in ambulatory surgery. Recurrence rate is higher than that observed in resective techniques. Progressive implementation subject to normal day case criteria is easily achievable (AU)