الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 2 |  |  |
| | | from | 2 | | |
Abstract
Fistula in ano is a common condition with an incidence of 5.6 per 100.000 in women and 12.3 per 100.000 in men in USA. The management of fistulas crossing the upper half of the external anal sphincter, however, remains a surgical challenge, as laying it open may result in variable degrees of incontinence. Surgical procedures include seton placement, mucosal advancement flap, fibrin glue injection and anal plug. Seton usually has to be removed after 3 months in addition to its effect on quality of life. Mucosal advancement flaps are not only technically challenging but also have recurrence rates that vary from 0% to 63%. Fibrin glue injection is a technically easy, low-risk technique; however, results have been disappointing, with success rates as low as 16%. Similarly, the use of the anal fistula plug is a simple, sphincter-sparing technique, but one whose long-term efficacy is questionable, with reported success ranging between 29% and 87%. Recently, Rojanasakul developed “the Ligation of Intersphincteric Fistula Tract (LIFT) technique”. As described, the technique disconnects the internal opening from the fistulous tract and removes the infected anal gland residual, without dividing any part of the anal sphincter complex.
The aim of this study was to evaluate the LIFT technique for the treatment of transsphincteric anal fistula involving the upper half of anal sphincter.
This study included 30 patients with transsphincteric anal fistula involving the upper half of anal sphincter. Anal fistula due to specific disease and other types of anal fistulas low intersphincteric, suprasphincteric and extrasphincteric have been excluded from the study.
Regarding demographic data, 73.3% of the included patients were males and the mean age was 37 years. Eight patients (26.7%) had history of previous surgery for anal fistula. The median duration of symptoms was 8 months. By digital rectal examination, six patients (20%) had more than one track and the median distance from the anal verge was 4 cm.
The LIFT procedure was performed by 5 different surgeons. The mean operative time was 36 minutes. There were no intraoperative complications. Five postoperative complications were observed, the most common complication was wound dehiscence. Other reported postoperative complications were perianal abscesses, anal fissures, fecal impaction and urine retention. No patients reported de novo incontinence, and most patients reported normal control. The median time for wound healing was 4 weeks. There was statistically significant improvement of quality of life measures 2 weeks and 4 weeks after the operation.
The main finding of this study was overall healing of 86.7% of patients, with a 6 months follow-up. There were 1 failure and 3 recurrences between 3 and 6 months after surgery. Regarding predictors of recurrence, no factors revealed statistically significant influence on recurrence using multivariate analysis.