Background
Treatment of a perianal fistula is difficult due to the risk of fecal incontinence and recurrence. The ligation of intersphincteric tract (LIFT) procedure is a sphincter-saving procedure associated with quite impressive preliminary results, with more than 90% of patients achieving complete healing within a mean duration of 4 weeks and without any disturbance of the continence state. The aim of this review was to prospectively compare the LIFT procedure with fistulotomy as a treatment for trans-sphincteric anal fistulas with respect to healing time, overall healing rate, recurrence, continence, morbidity, and postoperative pain.
Patients and methods
This study was performed on 30 patients with trans-sphincteric anal fistulas who underwent LIFT and fistulotomy from January 2021 to August 2021 at our Surgery Department of Zagazig University Hospitals in Egypt. All patients were followed up for 6 months through regular visits in the outpatient clinic. The primary end point of the study was healing, whereas the secondary outcome measures were recurrence rate, morbidity, postoperative pain, and incontinence rate.
Results
Healing rate in the LIFT group was 92 versus 70% in the fistulotomy group (=0.08). There was a highly significant difference in favor of LIFT group regarding fecal incontinence (=0.0004). Recurrence occurred in two patients in the LIFT group versus four patients in the fistulotomy group. Postoperative pain scores, patient satisfaction, and time taken to return to normal activities were significantly better in the LIFT arm. There was a highly significant difference in favor of LIFT group in the following complications: hemorrhage (=0.0008), urinary retention (=0.0001), delayed wound healing (=0.0004), and persistent pain (=0.0002). Only a small number of postoperative complications were reported in the fistulotomy group, including a thrombosed external hemorrhoid (=1), anal fissure (=2), anal stenosis (=3), and bleeding (=2). The bleeding did not require reoperation or hospital readmission.
Conclusion
The LIFT procedure has the advantages of preservation of the anal sphincters, minimal tissue injury, short healing time with no additional costs, and relatively easy procedure.