Early experience with the modificated approach of ligation of the intersphincteric fistula tract for high transsphincteric fistula.

Abstract

Transsphincteric fistulotomy is associated with a variable degree of fecal 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%. We evaluated a modified approach from it. Our aim was to review the preliminary results using this technique for high transsphincteric fistula. A retrospective analysis of a consecutive series of high transsphincteric fistula patients who underwent the modified LIFT (mLIFT) procedure was performed. The surgical technique involved making a lateral incision from external opening to intersphincteric groove; ligation of the fistula tract within the intersphincteric space; and complete excision of the distal part of fistula from external opening to external sphincter. The patients were followed for healing time, recurrence, fecal continence disturbance, and any other associated morbidity. Over a 2-year period, 43 patients with high transsphincteric anal fistula were treated by mLIFT technique. Four patients were lost at follow-up. In a mean follow-up of 15 months, 34/39 (87.2%) of the patients achieved primary or secondary healing. Five patients had persistent symptoms and required further surgical treatment. The second procedures were successful, and finally resulting in an overall healing rate of 100%. The Wexner incontinence scale was 0 (0-20) both before and at 6 months after the procedure. The mLIFT procedure for high transsphincteric fistula appeared to effectively preserve continence and achieved a comparable success rate to other sphincter-preserving techniques.