Al Sebai Olfat I, Ammar Mohammed S, Mohamed Samy H, El Balshy Mohammed A
General and Colorectal Surgery, Faculty of Medicine, Menoufia University, Egypt.
General Surgery, Faculty of Medicine, Menoufia University, Egypt.
Ann Med Surg (Lond). 2020 Dec 18;61:180-184. doi: 10.1016/j.amsu.2020.12.014. eCollection 2021 Jan.
Fistula-in-ano is one of the most common benign anal conditions in daily surgical practice.The goals in the treatment of an anal fistula are to eradicate sepsis and to eliminate the primary fistula opening, any associated tracts, and any secondary openings without a change in continence. Conventional fistulotomy (lay open of the fistula tract) is a commonly used procedure and is still relied on by the majority of surgeons as the gold standard for the treatment of perianal fistula. Ligation of the Intersphincteric Fistula Tract (LIFT) is a new sphincter-preserving technique for the treatment of anal fistula.
To compare the efficacy of open fistulotomy and ligation of intersphincteric fistula tract (LIFT) procedure based on its post-operative outcomes.
The Present study is A prospective randomized controlled trial which included 30 patients presented with low transsphincteric perianal fistula 27 (90%) males and 3 (10%) females divided into two groups each group consisted of 15 patients. Group, I subjected to inter sphincteric ligation of perianal fistula (LIFT) procedure. Group II patients subjected to conventional fistulotomy. The study lasts 2 years from May 2017 to May 2019 with Follow up for 6 months duration. Operative time in our study was significantly higher in group (I) Managed by LIFT with a mean of 32.53 min than group (II) managed by fistulotomy with a mean of 20.87mins. Wound healing was faster in a group (I) managed by LIFT than group (II) managed by fistulotomy, as the mean time for complete wound healing was (4.53) weeks after LIFT and (5.67) weeks after fistulotomy.
There was no case of incontinence after performing the LIFT technique in all our patients in group I. there were 2 cases of incontinence to gases only after fistulotomy in group II. The healing rate after LIFT was 80% (12/15 patients). The healing rate after fistulotomy was 93.3% (14/15 patients).
LIFT procedure is an effective and preferred sphincter-saving technique for fistula-in-ano with shorter healing time and lower incidence of postoperative anal incontinence, as compared to open fistulotomy.
肛瘘是日常外科手术中最常见的良性肛门疾病之一。肛瘘治疗的目标是根除感染并消除原发性瘘口、任何相关瘘管及任何继发性开口，同时不改变控便能力。传统的肛瘘切开术（瘘管敞开）是一种常用的手术方法，大多数外科医生仍将其作为肛周肛瘘治疗的金标准。括约肌间瘘管结扎术（LIFT）是一种治疗肛瘘的新的保留括约肌技术。
基于术后结果比较开放式肛瘘切开术和括约肌间瘘管结扎术（LIFT）的疗效。
本研究是一项前瞻性随机对照试验，纳入30例低位经括约肌型肛周肛瘘患者，其中男性27例（90%），女性3例（10%），分为两组，每组15例。第一组接受肛周肛瘘括约肌间结扎术（LIFT）。第二组患者接受传统的肛瘘切开术。研究从2017年5月至2019年5月持续2年，随访6个月。在我们的研究中，采用LIFT治疗的第一组手术时间明显更长，平均为32.53分钟，而采用肛瘘切开术治疗的第二组平均为20.87分钟。采用LIFT治疗的第一组伤口愈合比采用肛瘘切开术治疗的第二组更快，LIFT术后伤口完全愈合的平均时间为（4.53）周，肛瘘切开术后为（5.67）周。
在第一组所有接受LIFT技术治疗的患者中，无一例出现失禁情况。第二组肛瘘切开术后有2例仅出现气体失禁。LIFT术后愈合率为80%（12/15例患者）。肛瘘切开术后愈合率为93.3%（14/15例患者）。
与开放式肛瘘切开术相比，LIFT手术是一种治疗肛瘘的有效且更优的保留括约肌技术，愈合时间更短，术后肛门失禁发生率更低。
