Evaluation of Ligation of Intersphincteric Fistula Tract for the Treatment of Complex Fistula in-ano with Sphincter Saving Technique

Introduction & Management of complex fistula has two important long term closure of the tract and preservation of sphincter complex function. This study introduces a novel sphincter sparing technique called LIFT (ligation of intersphincteric fistula tract) with encourage results in controlling the perianal sepsis. All patients with complex fistula were treated with LIFT and they were prospectively followed. Demographic data, previous repair attempts, the type of treatment and score of fecal continence were collected. The procedure was performed by trained colorectal surgeons. The patients were followed for 12 to 50 weeks. A total of 23 patients underwent LIFT during 12 months. The median age of the patients was 35 years and 50 % had two previous attempts at surgery. A total of 18 patients (78%) had high transsphincteric fistula. Median follow up was 32 weeks. Successful fistula closure was achieved in 74% of the patients (17 of 23).Median time of recurrence was 4.5 weeks. One (4.3%) patient reported for gas incontinence (score: 3) after the procedure. LIFT is a novel treatment method for complicated fistula- in ano. It’s success rate is comparable with other sphincter sparing procedures. Furthermore LIFT is easy to learn and has very low cost. More importantly, it appears to be a safe procedure. Durability and efficacy of the procedure must be confirmed by long-term follow up and randomized control clinical trials.