Long-term outcomes in patients after ligation of the intersphincteric fistula tract

INTRODUCTION: Ligation of the intersphincteric fistula tract (LIFT) to treat transsphincteric fistulae has yielded varied but promising results. However, it has been shown that long-term follow-up (> 250 days) is vital to obtain the correct surgical outcome. Here, we present the long-term results of patients undergoing the LIFT procedure at Herlev Hospital, Denmark.

METHODS: The study was based on a retrospective chart review of 65 consecutive patients who underwent the LIFT procedure for transsphincteric fistula-in-ano in 2011-2015.

RESULTS: At the first follow-up, at a median 50 (interquartile range (IQR): 29-92) days, there were 28 recurrences of which 17 were transsphincteric. At the long-term follow-up, a median of 274 (IQR: 162-573) days, 16 patients (ten of whom were asymptomatic at the first follow-up) presented with a recurrence, of which seven were transsphincteric; 27 patients (42%) showed complete fistula healing following their initial LIFT surgery. Another 29 patients presented complete healing after repeated surgical treatment (additional LIFT, advancement flap and/or simple incision/fistulotomy), yielding a positive outcome in 86% of our patients.

CONCLUSION: The present study shows that the LIFT procedure is a viable treatment option for transsphincteric fistulae. Furthermore, a second LIFT procedure is a plausible option for recurrent transsphincteric fistulae. In the case of recurrence, the fistula was frequently downgraded to a more benign intersphincteric variant. The study supports previous findings showing that long-term follow-up is required to successfully measure the outcome of LIFT surgery.

FUNDING: none.

TRIAL REGISTRATION: not relevant.