Warning: fopen(/home/virtual/colon/journal/upload/ip_log/ip_log_2025-02.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 95 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 96 Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up
Skip Navigation
Skip to contents

Ann Coloproctol : Annals of Coloproctology

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > Ann Coloproctol > Ahead of print > Article
Original Article
Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up
Leichang Zhang1orcid, Chuanyu Zhan2orcid, Lu Li1,4orcid, Wanjin Shao3orcid, Guidong Sun4orcid, Yugen Chen4orcid, Guanghua Chen1orcid, Yulei Lang2orcid, Zenghua Xiao2orcid, Xiao Xiao2orcid

DOI: https://doi.org/10.3393/ac.2024.00024.0003
Published online: January 17, 2025

1Department of Colorectal Surgery, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China

2Department of Colorectal Surgery, Graduate School of Jiangxi University of Chinese Medicine, Nanchang, China

3Department of Colorectal Surgery, Shenzhen Municipal Coloproctology Hospital of Chinese Medicine, Shenzhen, China

4Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China

Correspondence to: Lu Li, MD Department of Colorectal Surgery, Affiliated Hospital of Jiangxi University of Chinese Medicine, No. 445, Bayi Ave, Nanchang 331300, China Email: ligelu111@163.com
Co-correspondence to: Wanjin Shao, FASCRS Department of Colorectal Surgery, Shenzhen Municipal Coloproctology Hospital of Chinese Medicine, No.1 Songling Rd.Shenzhen 518032, China Email: njdoctorswjw@163.com
• Received: January 11, 2024   • Revised: August 24, 2024   • Accepted: August 31, 2024

© 2025 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 271 Views
  • 14 Download
  • 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 1/3 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.
Anal fistula is a prevalent anorectal condition, with transsphincteric fistula being one of its primary subtypes. This type of fistula characteristically passes through both the internal and external sphincters. Traditionally, simple anal fistulas were treated with fistulotomy, a surgical approach that has reported cure rates exceeding 90% in some studies [1]. However, this procedure often results in damage to the anal sphincter, particularly in cases of high transsphincteric anal fistulas. To address the need for sphincter preservation, Rojanasakul et al. [2] introduced the concept of the ligation of the intersphincteric fistula tract (LIFT).
The main purpose of LIFT is to ligate and excise the intersphincteric portion of the fistula, thereby preventing infection from entering the tract and preserving the integrity of the sphincter. Studies have reported that the cure rates for this procedure range from 57% to 87.65% [36]. These variations in results can be attributed to factors such as the location of the fistula, the duration of follow-up, and the surgeon’s skill level. In a meta-analysis by Emile et al. [7], which included 1,378 patients with a median follow-up period of 16.5 months, a success rate of 76.5% was achieved, with only 1.4% of patients experiencing fecal incontinence. Although the cure rate is slightly lower than that of fistulotomy, the lesser extent of tissue loss and the preservation of anal function still offer significant advantages.
To examine the factors affecting the success of LIFT treatment, Liu et al. [8] analyzed 38 patients who underwent LIFT surgery. They discovered that an increase in fistula length was associated with a reduced success rate of the technique. Abcarian et al. [9] followed 40 patients who received LIFT treatment and observed that those with a history of more than 2 surgeries prior to LIFT treatment exhibited a lower cure rate, which decreased from 90% to 65%. Very few studies have explored the proportion of patients with a previous history of fistula surgery, the height and length of the fistula, and whether it was combined with other procedures. Therefore, these factors have not been definitively identified as confounding factors influencing the success of LIFT treatment [10, 11].
In this study, we conducted a retrospective review and analysis of 82 patients with high transsphincteric anal fistulas who were treated using the LIFT procedure in the anorectal departments of a dual-center institution.
Ethics statement
This study was approved by the ethics committees of the Affiliated Hospital of Nanjing University of Chinese Medicine (No. 2022NL-004-02) and the Affiliated Hospital of Jiangxi University of Chinese Medicine (No. JZFYJSLL20220120014). All participants provided signed informed consent prior to surgery.
Eligibility criteria
This retrospective analysis included 62 patients with high transsphincteric anal fistulas treated by LIFT at the colorectal department of the Affiliated Hospital of Nanjing University of Chinese Medicine (Nanjing, China), and 20 patients at the Affiliated Hospital of Jiangxi University of Chinese Medicine (Nanchang, China). The cases selected involved high transsphincteric fistulas affecting at least 1/3 of the external sphincter, anterior transsphincteric fistulas in women, and high transsphincteric fistulas accompanied by ischiorectal abscesses or multiple tracts. These conditions were confirmed through magnetic resonance imaging (Fig. 1) and clinical examinations [12]. Patients with inflammatory bowel disease, malignant neoplasms, rectovaginal fistulas, and tuberculous fistulas were excluded from the study. Before undergoing surgery, all patients were assessed to have good anal function and showed no symptoms of incontinence.
Referring to the report by Tan et al. [13], the outcomes were classified as either "cure" or "failure." The term "cure" was used to describe the complete resolution of symptoms, healing of the external opening, and closure of the intersphincteric incision. Conversely, "failure" was defined as the continued presence of pus at the external opening or intersphincteric incision, or the recurrence of an anal fistula in a previously healed wound. Fecal incontinence was evaluated using the Wexner incontinence scoring system both before and 3 months after surgery. In this system, a score of 0 indicates normal function, while a score of 20 signifies complete fecal incontinence. Higher scores represent more severe fecal incontinence [14]. The perioperative variables assessed included the length of the fistula, history of previous abscess or fistula surgery, the number of external openings or fistulas, and the location of the fistula. After discharge, follow-up assessments were conducted either during clinic visits or via telephone interviews weekly for the first 4 weeks, then at 3 months, 6 months, and annually thereafter.
Procedure
Surgery was performed in the lateral or folding knife position, using subarachnoid block anesthesia. Hydrogen peroxide was injected through the external opening to identify the internal opening, followed by the insertion of a ball-ended probe through the external opening, which was then threaded out through the internal opening. A curved intersphincteric incision approximately 1 to 2 cm in length was made (Fig. 2A). The intersphincteric fistula was then dissected, and right-angle forceps were used to grasp it (Fig. 2B). The internal and external sides of the intersphincteric fistula were each suture ligated using 3-0 Vicryl (Ethicon Inc). Hydrogen peroxide was infused through the external opening; the absence of bubbles overflowing from the internal opening confirmed successful ligation. The tract was divided between the 2 ligation points, and as much of it as possible was removed. The ligation points were then reinforced with additional sutures to ensure the ligature sutures remained secure (Fig. 2C). Hydrogen peroxide was infused again through the external opening, and the absence of bubbles from the intersphincteric incision confirmed the security of the ligation. Any necrotic tissue within the tract from the external opening to the external sphincter was removed. The intersphincteric incision was loosely closed, and the external opening was left open to allow for drainage (Fig. 2D). Postoperatively, antibiotics were administered routinely for 3 days, controlled defecation was maintained for 2 days, and dressing changes were performed daily. Anal sitz baths were not recommended.
Statistical analysis
Data were analyzed using IBM SPSS ver. 20.0 (IBM Corp). Measurement data were presented as means with lower and upper quartiles. Count data were expressed as frequency and percentage and compared using the chi-square test or the Fisher exact test. A P-value of less than 0.05 was considered statistically significant.
The study involved 82 patients, comprising 58 men (70.7%) and 24 women (29.3%), aged between 18 and 60 years, with a mean age of 40.11±8.16 years. The average duration of the disease was 8.93±4.08 months, ranging from 1 to 18 months. All 82 patients were classified as grade II (transsphincteric fistula) according to the Parks classification. In the St James’s Hospital University classification, all were categorized as grade IV (complex transsphincteric fistula). According to the Garg classification, 78 cases were grade III (high transsphincteric fistula with a single branch and anterior fistula in women), and 4 cases were grade IV (high transsphincteric fistula with multiple tracts, abscesses, or a horseshoe tract) [15]. Notably, 13 patients (16.9%) had a history of 1 or 2 incidents of anal fistula or abscesses that required incision and drainage. The length of the tract, measured as the direct linear distance from the external skin opening to the anal verge [8], ranged from 2 to 8 cm, with a median length of 3 cm. Regarding the location, 53 fistulas (64.6%) were anterior (lithotomy position, 1-12-11 points), 7 (8.5%) were posterior (5-6-7 points), 20 (24.4%) were lateral (2-4 and 8-10 points), and 2 (2.5%) were horseshoe-shaped (Table 1).
Surgery proceeded smoothly in all patients,the median operation time was 48.9 minutes, with operation times ranging from 20 to 80 minutes. No intraoperative or postoperative complications were noted. Out of the total number of patients, 77 were successfully followed up after surgery, while 5 were lost to follow-up for various reasons. The duration of postoperative follow-up varied from 4 to 120 months, with a me­dian duration of 85.5 months. According to the postoperative follow-up statistics, 58 patients experienced complete healing. Another 4 patients developed intersphincteric wound dehiscence and infection, which were managed with dressing changes and subsequently healed, resulting in an overall effective rate of 80.5%. Within a postoperative period ranging from 3 to 18 months, 15 patients (19.5%) experienced surgical failure, with a median time to failure of 11 months. Six patients (7.8%) suffered a "partial failure," which meant a fistula persisted from an unhealed internal opening to the intersphincteric wound; these were resolved by fistulotomy. Nine patients (11.7%) suffered a "complete failure," which meant a tract persisted from the previous internal opening to an external opening with a healed intersphincteric wound (Table 1). Among these, 5 patients underwent fistulotomy, 1 patient was treated with the loose seton technique, and 3 patients received treatment in other hospitals. During the postoperative follow-up, only 1 patient reported minor overflow issues when passing excessive gas and had a Wexner score of 1. This symptom was infrequent, and we recommended that the patient perform Kegel exercises. No other patients reported symptoms of incontinence, and their Wexner scores were 0.
There were no statistically significant differences between the cured and failed groups regarding fistula length, history of previous fistula or abscess surgery, number of fistulas or external openings, and fistula location (all P>0.05) (Table 2).
The LIFT procedure is an advanced technique that offers numerous benefits for sphincter preservation. It is distinguished by minimal tissue damage, a short healing period, a mild impact on the sphincter, and virtually no effect on anal function. In our study, patients were followed for a period ranging from 4 to 120 months, achieving an overall cure rate of 80.5% for this procedure. No intraoperative or postoperative complications were reported, with the exception of one patient who experienced minor overflow. Although there were differences in patient enrollment and follow-up duration compared to previous studies, our findings were similar. This study exclusively included complex anal fistulas—78 cases were classified as Garg grade III and 4 cases as grade IV. Simple anal fistulas (Garg grades I and II) were not included, which may limit the ability to fully assess the impact of the Garg classification on the success rate of the LIFT procedure. Nevertheless, the Garg classification remains crucial for determining the severity of the condition and guiding its management [15].
Among the 77 patients who were not lost to follow-up in our study, we observed no statistically significant differences in fistula length, history of previous anal fistula/abscess surgeries, number of fistulas/external openings, and fistula location between patients who were surgically cured and those who were not. These findings do not provide a direct predictive basis for determining the influence of these factors on the success of LIFT treatment. However, our results indicated a significantly higher occurrence of anterior fistulas compared to other locations, which may be related to case selection. We hypothesize that the success of LIFT in treating anterior fistulas could be due to the relative weakness of the anterior sphincter in women, which is more susceptible to injury. This suggests that LIFT, with its principle of sphincter protection, offers distinct advantages in such cases.
In our practice, we have identified several factors that may lead to the failure of LIFT treatment. First, there is a learning curve for young physicians adopting new techniques. The success rate of the procedure is influenced by the degree of mastery of the technique and the level of surgical performance. Challenges such as a narrow intersphincteric space and intraoperative bleeding can compromise the surgical field of vision, making it difficult to differentiate between normal tissue and the fistula. This can lead to complications such as breaking the intersphincteric fistula, leaving behind a branched tract, slipping off the ligature line, or incomplete ligation. Second, issues such as an overly large internal opening or an intersphincteric fistula in the abscess stage can impact treatment outcomes. Some scholars recommend waiting 8 to 12 weeks after hook-up to allow for complete drainage, inflammation control, and fistula maturation before surgery, which could lead to a higher cure rate [16]. Third, the complexity of intersphincteric fistulas (e.g., the presence of a high blind fistula in the intersphincteric area, secondary internal openings in the rectum, or suprasphincteric fistulas) makes surgery challenging. The deep separation of the sphincters and limited space for surgical visualization further add to the difficulty. Lastly, a previous history of fistulas or abscess surgery and scarring from previous surgeries may alter the structure of the surgical anatomy, resulting in failure to correctly access the intersphincteric space and affecting the success of the procedure. Therefore, a thorough understanding of the indications for LIFT treatment, familiarity with the unique anatomical structure of the intersphincteric space, and precise surgical technique are crucial for successful surgical outcomes.
In our opinion, the following points should be noted intraoperatively. First, when making a curved intersphincteric incision, it is crucial to position the incision as close to the outer side of the intersphincteric space as possible. This approach helps prevent infections that could arise from an incision made too close to the anus. If there is no emission of air bubbles from the anus after injecting hydrogen peroxide, or if probing from the inner opening is unsuccessful, the incision site should be determined using palpation and preoperative magnetic resonance imaging. Second, the intersphincteric plane should be carefully separated under the guidance of a probe. It is essential to accurately identify the internal and external sphincters and any intersphincteric fibrotic fistula, especially in patients with a history of fistula surgery and resultant surgical scars. Third, the fistula should be ligated as close as possible to both sides of the intersphincteric fistula, and as much of the tract as possible should be resected. Subsequently, the 2 points of ligation should be reinforced with additional sutures to prevent the ligature sutures from dislodging. Lastly, after ligation of the intersphincteric fistula, hydrogen peroxide can be injected through the external opening to confirm that the fistula has been blocked. Following resection, hydrogen peroxide should be injected through the external opening again to ensure that the intersphincteric tract has been completely closed.
According to the available literature, most surgical failures occur within 6 months postoperatively, with late failures occurring up to 12 months postoperatively [8]. In our study, the median time to surgical failure was 11 months, underscoring the necessity of a minimum postoperative follow-up period of 1 year. Understanding the type of surgical failure can help guide the follow-up treatment to maximize the cure rate. LIFT treatment failure generally manifests in 3 forms [13]:
  • (1) In cases where only the intersphincteric incision has split, the treatment may simply involve changing the medication or curetting the granulation tissue, after which the wound heals on its own.

  • (2) If the original external opening has been closed and a new external opening forms in the intersphincteric region, it indicates the transition of a transsphincteric fistula into an intersphincteric fistula. In this “descending phase,” follow-up treatment can be simplified.

  • (3) When the external opening continues to discharge pus and secretions, indicating that the fistula persists or recurs as a transsphincteric fistula, the options include repeating LIFT or choosing other sphincter-preserving surgical procedures.

For patients with persistent symptoms, incision and drainage of any abscess should be performed promptly in the early stages. Local dressing changes and care may continue for up to 6 months or longer. During this period, some patients’ wounds may heal on their own, which helps to avoid excessive surgery. However, if symptoms are further aggravated or persist after 6 months, further preoperative evaluation is needed to guide the next treatment plan.
All operations in this study were performed by 2 experienced surgeons, mitigating the risk of lower cure rates resulting from inadequate surgical skills. However, due to its retrospective nature and small sample size, the study did not adequately capture the influence of patients' previous anal fistula treatment history, the characteristics of the fistulas, and their locations on the outcomes of LIFT treatment. Additionally, the evaluation of anal function was not supported by objective data. Consequently, a prospective randomized controlled study with a larger sample size and an extended follow-up period is essential to more thoroughly investigate the impact of LIFT on treating patients with fistulas.
Although LIFT is not suitable for all types of fistulas, it is a safe and effective sphincter-preserving surgery with minimal complications. This technique minimizes damage to muscles and other anatomical structures, thereby preserving anal function. Additionally, it can simplify the management of complex cases, as dealing with an intersphincteric fistula becomes more straightforward. A thorough understanding of the surgical indications and meticulous execution of the procedure can lead to a high cure rate.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

This work was supported by the National Natural Science Foundation of China (No. 82260938).

Acknowledgments

The authors thank Professor Wanjin Shao's team from the Affiliated Hospital of Shenzhen Municipal Coloproctology Hospital of Chinese Medicine (Shenzhen, China) and Professor Leichang Zhang's team from the Affiliated Hospital of Jiangxi University of Chinese Medicine (Nanchang, China) for their strong support to this study.

Author contributions

Conceptualization: all authors; Data curation: CZ, GC, YL; Funding acquisition: LZ, LL; Investigation: WS, LZ; Methodology: all authors; Visualization: ZX, XX; Writing–original draft: LZ, LL; Writing–review & editing: all authors; All authors read and approved the final manuscript.

Fig. 1.
Magnetic resonance imaging of 3 typical types of ligation of the intersphincteric fistula tract (LIFT) indications. (A) Axial T2-weighted fat-suppressed sequence shows an anterior (A) transsphincteric fistula in a female patient (arrows). (B) Axial T2-weighted sequence shows that a posterior (P) fistula passes through the superficial external sphincter in a female patient (arrow). (C) Axial T2-weighted sequence shows that a right ischiorectal-abscess fistula passes through the superficial external sphincter, with clear fibrotic tract in the intersphincteric space (arrow). L, left; R, right.
ac-2024-00024-0003f1.jpg
Fig. 2.
Operative technique of ligation of the intersphincteric fistula tract (LIFT). (A) The intersphincteric tract is exposed. (B) The intersphincteric tract is isolated by right-angle forceps. (C) Ligation of the intersphincteric tract. (D) Postoperative picture showing suturing of the intersphincteric incision.
ac-2024-00024-0003f2.jpg
Table 1.
Patient characteristics and results
Characteristic Value (n=82)
Lost to follow-up 5 (6.1)
Follow-up (mo) 85.5 (4–120)
Age (yr) 33.5 (18–60)
Sex
 Male 58 (70.7)
 Female 24 (29.3)
History of previous fistula/abscess surgery (n=77) 13 (16.9)
Fistula length (cm) 3 (2–8)
Fistula position
 Anterior 53 (64.6)
 Posterior 7 (8.5)
 Lateral 20 (24.4)
 Horseshoe 2 (2.5)
Total cure rate (n=77) 62 (80.5)
Failure rate (n=77) 15 (19.5)
 Partial failure 6 (7.8)
 Complete failure 9 (11.7)

Values are presented as number (%) or median (range).

Table 2.
Univariate analysis of predictors of failure after LIFT (n=77)
Predicator Cured (n=62) Failed (n=15) P-value
Fistula length (cm) 0.936
 ≤3 (n=52) 42 (80.8) 10 (19.2)
 >3 (n=25) 20 (80.0) 5 (20.0)
History of previous fistula/abscess surgery 0.260
 Yes (n=13) 9 (69.2) 4 (30.8)
 No (n=64) 53 (82.8) 11 (17.2)
≥2 Fistulas/external openings 0.101
 Yes (n=7) 4 (57.1) 3 (42.9)
 No (n=70) 58 (82.9) 12 (17.1)
Fistula position 0.882
 Anterior (n=48) 38 (79.2) 10 (20.8)
 Posterior (n=7) 6 (85.7) 1 (14.3)
 Lateral (n=20) 16 (80.0) 4 (20.0)
 Horseshoe (n=2) 2 (100) 0 (0)

LIFT, ligation of the intersphincteric fistula tract.

  • 1. Abramowitz L, Soudan D, Souffran M, Bouchard D, Castinel A, Suduca JM, et al. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study. Colorectal Dis 2016;18:279–85. ArticlePubMed
  • 2. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai 2007;90:581–6. PubMed
  • 3. Wood T, Truong A, Mujukian A, Zaghiyan K, Fleshner P. Increasing experience with the LIFT procedure in Crohn’s disease patients with complex anal fistula. Tech Coloproctol 2022;26:205–12. ArticlePubMedPDF
  • 4. Sirikurnpiboon S. The risk factors for failure and recurrence of LIFT procedure for fistula in ano. Turk J Surg 2023;39:27–33. ArticlePubMedPMCPDF
  • 5. Sun XL, Wen K, Chen YH, Xu ZZ, Wang XP. Long-term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas. Colorectal Dis 2019;21:30–7. ArticlePubMedPDF
  • 6. Malakorn S, Sammour T, Khomvilai S, Chowchankit I, Gunarasa S, Kanjanasilp P, et al. Ligation of intersphincteric fistula tract for fistula in ano: lessons learned from a decade of experience. Dis Colon Rectum 2017;60:1065–70. ArticlePubMed
  • 7. Emile SH, Khan SM, Adejumo A, Koroye O. Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: an updated systematic review, meta-analysis, and meta-regression of the predictors of failure. Surgery 2020;167:484–92. ArticlePubMed
  • 8. Liu WY, Aboulian A, Kaji AH, Kumar RR. Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum 2013;56:343–7. ArticlePubMed
  • 9. Abcarian AM, Estrada JJ, Park J, Corning C, Chaudhry V, Cintron J, et al. Ligation of intersphincteric fistula tract: early results of a pilot study. Dis Colon Rectum 2012;55:778–82. ArticlePubMed
  • 10. Bayrak M, Altintas Y. Predictive factors affecting recurrence of anal fistula after LIFT procedure. J Coll Physicians Surg Pak 2022;32:1470–3. ArticlePubMed
  • 11. Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery? Dis Colon Rectum 2012;55:1173–8. ArticlePubMed
  • 12. Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 2000;20:623–37. ArticlePubMed
  • 13. Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum 2011;54:1368–72. ArticlePubMed
  • 14. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97. ArticlePubMed
  • 15. Garg P. Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients: cohort study. Ann Med Surg (Lond) 2020;59:122–6. ArticlePubMedPMC
  • 16. Sirany AM, Nygaard RM, Morken JJ. The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results. Dis Colon Rectum 2015;58:604–12. ArticlePubMed

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • Cite this Article
        Cite this Article
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up
      Image Image
      Fig. 1. Magnetic resonance imaging of 3 typical types of ligation of the intersphincteric fistula tract (LIFT) indications. (A) Axial T2-weighted fat-suppressed sequence shows an anterior (A) transsphincteric fistula in a female patient (arrows). (B) Axial T2-weighted sequence shows that a posterior (P) fistula passes through the superficial external sphincter in a female patient (arrow). (C) Axial T2-weighted sequence shows that a right ischiorectal-abscess fistula passes through the superficial external sphincter, with clear fibrotic tract in the intersphincteric space (arrow). L, left; R, right.
      Fig. 2. Operative technique of ligation of the intersphincteric fistula tract (LIFT). (A) The intersphincteric tract is exposed. (B) The intersphincteric tract is isolated by right-angle forceps. (C) Ligation of the intersphincteric tract. (D) Postoperative picture showing suturing of the intersphincteric incision.
      Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up
      Characteristic Value (n=82)
      Lost to follow-up 5 (6.1)
      Follow-up (mo) 85.5 (4–120)
      Age (yr) 33.5 (18–60)
      Sex
       Male 58 (70.7)
       Female 24 (29.3)
      History of previous fistula/abscess surgery (n=77) 13 (16.9)
      Fistula length (cm) 3 (2–8)
      Fistula position
       Anterior 53 (64.6)
       Posterior 7 (8.5)
       Lateral 20 (24.4)
       Horseshoe 2 (2.5)
      Total cure rate (n=77) 62 (80.5)
      Failure rate (n=77) 15 (19.5)
       Partial failure 6 (7.8)
       Complete failure 9 (11.7)
      Predicator Cured (n=62) Failed (n=15) P-value
      Fistula length (cm) 0.936
       ≤3 (n=52) 42 (80.8) 10 (19.2)
       >3 (n=25) 20 (80.0) 5 (20.0)
      History of previous fistula/abscess surgery 0.260
       Yes (n=13) 9 (69.2) 4 (30.8)
       No (n=64) 53 (82.8) 11 (17.2)
      ≥2 Fistulas/external openings 0.101
       Yes (n=7) 4 (57.1) 3 (42.9)
       No (n=70) 58 (82.9) 12 (17.1)
      Fistula position 0.882
       Anterior (n=48) 38 (79.2) 10 (20.8)
       Posterior (n=7) 6 (85.7) 1 (14.3)
       Lateral (n=20) 16 (80.0) 4 (20.0)
       Horseshoe (n=2) 2 (100) 0 (0)
      Table 1. Patient characteristics and results

      Values are presented as number (%) or median (range).

      Table 2. Univariate analysis of predictors of failure after LIFT (n=77)

      LIFT, ligation of the intersphincteric fistula tract.


      Ann Coloproctol : Annals of Coloproctology Twitter Facebook
      TOP