Carlos Placer Galán1, Claudia Lopes2, José Andrés Múgica2, Yolanda Saralegui2, Nerea Borda2, José M Enriquez Navascues2. 1. Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, San Sebastián, España. Electronic address: carlos.placergalan@osakidetza.net. 2. Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, San Sebastián, España.
Abstract
OBJECTIVE: To study the recurrence/persistence rate of complex cripotoglandular anal fistula after the LIFT procedure and analyse the patterns of recurrence/persistence. PATIENTS AND METHODS: Observational study of patients with transe-sphincteric or supra-sphincteric anal fistula treated using the LIFT procedure from December 2008 to April 2016. Variables studied included clinical characteristics, surgical technique and results. Clinical cure was defined and imaging studies were used in doubtful cases. Wexner's score was used for continence evaluation. The minimum follow-up time was one year. RESULTS: A total of 55 patients were operated on: 53 with a trans-sphincteric fistula and 2 supra-sphincteric. There were 16 failures (29%): 7 complete fistulas (original), 6 intersphincteric (downstage), and 3 external residual tracts. A posterior location and complexity of the tract were risk factors for recurrence/persistence. The presence of a seton did not improve results. No case presented decrease of continence (Wexner 0). Nine patients presented minor complications (9%): 4 intersphincteric wounds with delayed closure and one external hemorrhoidal thrombosis. The median time to closure of the external opening was 5 weeks (IR 2-6). Intersphincteric wounds closed in 4-8 weeks. CONCLUSION: In our experience, the LIFT technique is a safe and reproducible procedure with low morbidity, no repercussion on continence and a success rate over 70%. There are 3types of recurrence: the intersphincteric fistula, the original fistulatula (trans- or supra-sphincteric) and the residual external tract. Considering the types of recurrence, only 12,7% of patients need more complex surgery to solve their pathology. The rest of the recurrences/persistence were solved by simple procedures (fistulotomy in intersphincteric forms and legrado in residual tracts).
OBJECTIVE: To study the recurrence/persistence rate of complex cripotoglandular anal fistula after the LIFT procedure and analyse the patterns of recurrence/persistence. PATIENTS AND METHODS: Observational study of patients with transe-sphincteric or supra-sphincteric anal fistula treated using the LIFT procedure from December 2008 to April 2016. Variables studied included clinical characteristics, surgical technique and results. Clinical cure was defined and imaging studies were used in doubtful cases. Wexner's score was used for continence evaluation. The minimum follow-up time was one year. RESULTS: A total of 55 patients were operated on: 53 with a trans-sphincteric fistula and 2 supra-sphincteric. There were 16 failures (29%): 7 complete fistulas (original), 6 intersphincteric (downstage), and 3 external residual tracts. A posterior location and complexity of the tract were risk factors for recurrence/persistence. The presence of a seton did not improve results. No case presented decrease of continence (Wexner 0). Nine patients presented minor complications (9%): 4 intersphincteric wounds with delayed closure and one external hemorrhoidal thrombosis. The median time to closure of the external opening was 5 weeks (IR 2-6). Intersphincteric wounds closed in 4-8 weeks. CONCLUSION: In our experience, the LIFT technique is a safe and reproducible procedure with low morbidity, no repercussion on continence and a success rate over 70%. There are 3types of recurrence: the intersphincteric fistula, the original fistulatula (trans- or supra-sphincteric) and the residual external tract. Considering the types of recurrence, only 12,7% of patients need more complex surgery to solve their pathology. The rest of the recurrences/persistence were solved by simple procedures (fistulotomy in intersphincteric forms and legrado in residual tracts).
Authors: Yee Chen Lau; Kilian G M Brown; Juyong Cheong; Christopher Byrne; Peter J Lee Journal: J Gastrointest Surg Date: 2019-06-25 Impact factor: 3.452