Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy.
Updates Surg. 2024 Jun;76(3):989-997. doi: 10.1007/s13304-024-01818-2. Epub 2024 Apr 4.
Ligation of the intersphincteric fistula tract has been recently employed as definitive treatment of anal fistulas. However, it carries a potential risk of continence impairment, fistula recurrence, and repeated operations. This study aimed to assess postoperative outcomes related to this procedure and evaluate the potential influence of preoperative and intraoperative features. Patients who underwent LIFT procedure between June 2012 and September 2021 were retrospectively analyzed. Patients were divided according to whether they developed fistula recurrence and on the history of a surgery prior to the LIFT. Preoperative features, postoperative outcomes, and risk factors adverse outcomes were analyzed. Forty-eight patients were included, of which 25 received primary LIFT, being the high transsphincteric fistula pattern the most frequent (62.5%). The median follow-up was 13.3 months, with a recurrence rate of 20.8%, of which the majority presented an intersphincteric fistula pattern (50%); and continence impairment rate of 16.7%. A higher prevalence of diabetes (p = 0.026) and a trend towards a higher prevalence of patients with a history of high transsphincteric fistula (0.052) were observed in the group with fistula recurrence. The history of diabetes and the operation time with a cut-off value ≥ 69 min showed a trend as a risk factors for developing fistula recurrence (0.06) and postoperative continence impairment (0.07), respectively. The LIFT procedure seems to be safe in terms of morbidity, with a reasonable incidence of recurrences, showing better results when it is primarily performed. Preoperative characteristics should be considered as they may impact outcomes.
括约肌间瘘管结扎术最近被用作肛门瘘管的确定性治疗方法。然而，它存在潜在的控便功能障碍、瘘管复发和反复手术的风险。本研究旨在评估该手术的术后结果，并评估术前和术中特征的潜在影响。回顾性分析了 2012 年 6 月至 2021 年 9 月间接受 LIFT 手术的患者。根据患者是否发生瘘管复发和在接受 LIFT 手术之前是否有过手术史进行分组。分析了术前特征、术后结果以及不良结果的危险因素。共纳入 48 例患者，其中 25 例接受了原发性 LIFT，最常见的是高位经括约肌瘘管模式（62.5%）。中位随访时间为 13.3 个月，复发率为 20.8%，其中大部分为括约肌间瘘管模式（50%）；控便功能障碍率为 16.7%。复发组中糖尿病的患病率较高（p=0.026），且有更高比例的患者有高位经括约肌瘘管病史（0.052）。糖尿病病史和手术时间（截值≥69 分钟）有较高的趋势，可能是发生瘘管复发（0.06）和术后控便功能障碍（0.07）的危险因素。LIFT 手术在发病率方面似乎是安全的，复发率合理，初次手术时效果更好。术前特征应被视为可能影响结果的因素。
