Annals of Coloproctology

Original Articles

Anorectal benign disease

Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up: Leichang Zhang, Chuanyu Zhan, Lu Li, Wanjin Shao, Guidong Sun, Yugen Chen, Guanghua Chen, Yulei Lang, Zenghua Xiao, Xiao Xiao; Ann Coloproctol. 2025;41(1):77-83. Published online January 17, 2025; DOI: https://doi.org/10.3393/ac.2024.00024.0003

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Abstract PDF: Purpose
This study aimed to evaluate the long-term efficacy of the ligation of the intersphincteric fistula tract (LIFT) procedure in treating high transsphincteric fistulas.
Methods
We conducted a retrospective study to evaluate the success rate of LIFT treatment in 82 patients with high transsphincteric fistulas involving at least one-third of the external sphincter. This study was carried out across 2 centers from November 2009 to February 2023.
Results
All patients underwent successful surgery with a median operative time of 48.9 minutes (range, 20–80 minutes), and no intraoperative or postoperative complications were reported. The median follow-up duration was 85.5 months (range, 4–120 months), with 5 patients (6.1%) lost to follow-up. Treatment was successful in 62 patients, whose symptoms disappeared and both the external opening and the intersphincteric incision completely healed, yielding an overall efficiency rate of 80.5%. There were 15 cases (19.5%) of treatment failure, including 6 (7.8%) that converted to intersphincteric anal fistula and 9 (11.7%) that experienced persistent or recurrent fistulas. Only 1 patient reported minor overflow during the postoperative follow-up, but no other patients reported any significant discomfort. There were no statistically significant differences between patients with surgical success and those with treatment failure in terms of fistula length, history of previous abscess or anal fistula surgery, number of external orifices or fistulas, and location of fistulas (all P>0.05).
Conclusion
LIFT is a safe and effective sphincter-preserving procedure that yields satisfactory healing outcomes and has minimal impact on anal function.

Anorectal benign disease

Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study: In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong; Ann Coloproctol. 2024;40(2):169-175. Published online February 6, 2023; DOI: https://doi.org/10.3393/ac.2022.00486.0069

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Abstract PDF

Purpose
Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes.
Methods
In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment.
Results
In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure.
Conclusion
We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Citations

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Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef

Surgery for a Complex Anal Fistula.: Hwang, Sung Hwan , Bang, Mi Ji; J Korean Soc Coloproctol. 2008;24(2):77-82.; DOI: https://doi.org/10.3393/jksc.2008.24.2.77

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2 Citations

Abstract PDF

PURPOSE
Because of the complexity and un-expectation of the courses and clinical features for the complex anal fistula, the management of it presents a difficult surgical challenge. Various techniques have been used, such as seton placement, advancement flap closure, muscle filling procedure, and fibrin glue injection. The classic lay-open and seton placement may distort the anal anatomy and result in poor functional outcomes, such as incontinence. Also, advancement flap techniques are associated with relatively high recurrence rates. This study assesses the results of surgery for a complex anal fistula, as performed in Hangun Hospital, Busan. Operative procedures were comprised of two or more separate procedures, including 1) a total fistulectomy, 2) muscle reconstruction, sometimes muscle transposition, 3) direct closure of the primary opening without making a mucosal advancement flap, and 4) a drainage procedure and/or other minor procedure. METHODS: Surgical procedures were performed on 22 patients (18 males) with a complex anal fistula between July 2004 and December 2004. The clinical and the manometric results were analyzed with respect to postoperative recurrence, delayed wound healing, and postoperative fecal incontinence. RESULTS: Nineteen of the 22 patients were completely healed without any sequelae. Treatment failure was encountered in one patient two months postoperatively, when an additional fistulotomy was performed to achieve a cure. There were two patients displaying delayed healing, who were successfully treated by curettage. No patient complained of postoperative fecal incontinence in either the clinical examination on the manometric study (mean resting pressure, 75.5+/-3.5 mmHg; maximal squeeze pressure, 175.7+/-10.3 mmHg). CONCLUSIONS: This short- term study suggests that a direct closure of the internal opening after a total fistulectomy can be an alternative surgical option for the treatment of a complex anal fistula.

Citations

Citations to this article as recorded by

Long-Term Results of Adipose-Derived Stem Cell Therapy for the Treatment of Crohn's Fistula
Yong Beom Cho, Kyu Joo Park, Sang Nam Yoon, Kee Ho Song, Do Sun Kim, Sang Hun Jung, Mihyung Kim, Hee Young Jeong, Chang Sik Yu
Stem Cells Translational Medicine.2015; 4(5): 532. CrossRef
New Techniques for Treating an Anal Fistula
Kee Ho Song
Journal of the Korean Society of Coloproctology.2012; 28(1): 7. CrossRef

The Clinical Effect of Sphincter-Preserving Modified Loose Seton Technique in Complex Anal Fistula.: Lee, Yun Young , Choi, Sun Keun , Kim, Sei Joong , Lee, Keon Young , Hur, Yoon Seok , Ahn, Seung Ik , Hong, Kee Chun , Shin, Seok Hwan , Woo, Ze Hong; J Korean Soc Coloproctol. 2002;18(3):156-162.

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Abstract PDF: PURPOSE
The cutting seton technique is a world-wide operative method in management of a complex anal fistula. However it has still some risks of anal deformity and fecal incontinence because of sphincter injury, and also required two-stage operation under the anesthesia. We have modified this conventional method into sphincter-preserving technique using the seton and evaluated the clinical effect of patients with complex anal fistula.
METHODS
The operative steps consisted of excision of the fistular tract without cutting the sphincter, and insertion of a non-absorbable suture material as a seton around the sphincter. When enough fibro-granulated tissues grew and pus discharge decreased markedly, the seton was just cut out from the wound without anesthesia at the outpatient basis. The clinical effect following treatment by using this method was assessed retrospectively in 81 patients, including 33 recurrent cases, who were treated during the four and a half-year period.
RESULTS
The average follow-up period to remove the seton and to eradicate the fistula was 68.9+/-39.5 and 82.1+/-45.6 days, respectively. No patients experienced fecal incontinence after surgery. The fistula was healed without recurrence in 78 patients (96.3%), preserving integrity of the sphincter. Recurrence developed in 3 patients who had two suprasphincteric fistulas and one transsphincteric fistula with supralevator abscess.
CONCLUSION
We suggest that this method is good for treating complex anal fistulas without two-stage operation because it has some advantages such as a lower recurrence, a lower functional impairment, and less anal deformity.

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