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Ligation of the Intersphincteric Fistula Tract: An Effective New Technique for Complex Fistulas

Bleier, Joshua I. S. M.D.1; Moloo, Husein M.D.2; Goldberg, Stanley M. M.D.3

Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181bb869f
Original Contribution
Abstract

INTRODUCTION: The management of complex fistulas is difficult. Maintaining continence while achieving durable fistula closure is the goal of surgical management. This study describes our experience with a novel sphincter-sparing technique called the ligation of the intersphincteric fistula tract, which involves ligation and division of the fistula tract in the intersphincteric space.

METHODS: All patients from July 2007 to December 2008 with trans- or suprasphincteric fistula treated with the procedure were prospectively followed. Procedures were performed by surgeons with fellowship training in a referral center. Demographic data, comorbidities, previous repair attempts, and postoperative data were collected.

RESULTS: A total of 39 patients underwent a ligation of the intersphincteric fistula tract during a 17-month period. Median age was 49 years. A total of 29 patients (74%) had previous attempts at repair, with a median of 2 failed repairs. Follow-up data were available in 90% (35 of 39). Median follow-up was 20 weeks. Successful fistula closure was achieved in 57% of the patients (20 of 35). Median time to failure was 10 weeks (range, 2–38 weeks). No patient reported any subjective decrease in continence after the procedure.

CONCLUSION: Ligation of the intersphincteric fistula tract is a new sphincter-sparing procedure for complex transsphincteric fistula. The success rate is comparable with other sphincter-preserving techniques. Importantly, it appeared to effectively preserve continence. Adding safe, muscle-sparing surgical options to our armamentarium for dealing with transsphincteric fistula is essential. Additionally, the procedure is easy to learn and has very low cost. Long-term follow-up and randomized, controlled trials are necessary to assess efficacy and durability.

Author Information

1 University of Pennsylvania, Pennsylvania Hospital, Colon and Rectal Surgery, Philadelphia, Pennsylvania

2 University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada

3 University of Minnesota, Division of Colon and Rectal Surgery, Minneapolis, Minnesota

Financial Disclosure: None reported.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, May 2 to 6, 2009.

Correspondence: Joshua I. S. Bleier, M.D., Assistant Professor of Surgery, Division of Colon and Rectal Surgery, Pennsylvania Hospital/Hospital of the University of Pennsylvania, 700 Spruce St., Suite 305, Philadelphia, PA 19106. E-mail: Joshua.bleier@uphs.upenn.edu

© The ASCRS 2010