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Long-term Results of Ligation of Intersphincteric Fistula Tract (LIFT) for Fistula-in-Ano

Liu, Wendy Y. M.D.1; Aboulian, Armen M.D.2; Kaji, Amy H. M.D., Ph.D.1; Kumar, Ravin R. M.D.1

Diseases of the Colon & Rectum: March 2013 - Volume 56 - Issue 3 - p 343–347
doi: 10.1097/DCR.0b013e318278164c
Original Contribution: Anorectal Disease

BACKGROUND: Ligation of intersphincteric fistula tract is a novel surgical technique in the treatment of transsphincteric fistula-in-ano that has been shown to be successful in the short term. Median follow-up in current literature ranges from 5 to 9 months. However, the long-term success rate is unknown.

OBJECTIVE: This study describes our long-term results in performing the ligation of intersphincteric fistula tract procedure.

DESIGN: This study is a retrospective review.

PATIENTS: Thirty-eight patients from August 2008 to October 2011 were evaluated.

INTERVENTIONS: All patients underwent the ligation of intersphincteric fistula tract for fistula-in-ano.

MAIN OUTCOME MEASURES: Patient and fistula characteristics, primary healing rate, secondary healing rate, previous treatments, and failures were reviewed.

RESULTS: The median follow-up was 26 months (range, 3–44 months), and 26 patients (68%) were followed for greater than 12 months. The overall primary healing rate was 61% (23 of 38), and it was 62% (16 of 26) in patients followed for over 12 months. Eighty percent (12/15) of the failures are early failures (persistent symptoms or failure at ≤6 months), and 20% are late failures (>6 months) with 1 failure occurring 12 months postprocedure. Increase in length of fistula tract was associated with decreased healing (OR 0.55, 95% CI 0.34–0.88, p = 0.01). There were no intraoperative complications and no reported incontinence.

CONCLUSION: Our study demonstrates favorable long-term results for the ligation of intersphincteric fistula tract procedure. It appears that long tracts negatively affect healing, and late failures can occur up to 12 months postoperatively. Understanding the type of failure can help guide subsequent treatment to maximize healing success.

1 Harbor-UCLA Medical Center, Division of Colon and Rectal Surgery, Torrance, California

2 Cleveland Clinic Foundation, Department of Colorectal Surgery, Cleveland, Ohio

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society for Colon and Rectal Surgeons, San Antonio, Texas, June 2 to 6, 2012

Correspondence: Ravin R. Kumar, M.D., Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, 1000 West Carson St, Box 25, Torrance, California 90502. E-mail:

© The ASCRS 2013