Van De Putte Dirk, Depuydt Martijn, Colpaert Jan, Van Ramshorst Gabrielle H
Gastrointestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Department of Surgery, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium.
Updates Surg. 2025 May 7. doi: 10.1007/s13304-025-02174-5.
Anal fistula treatment remains a surgical challenge. This study focuses on the efficiency and safety of the Ligation of Intersphincteric Fistula Tract (LIFT) procedure for high intersphincteric anorectal fistulas, aiming to identify prognostic factors for success and complications. A retrospective chart review was conducted on all patients who underwent LIFT procedure at a tertiary referral hospital between January 2013 and January 2021. The primary endpoint was the success rate of fistula closure, confirmed with clinical investigation. Secondary endpoints included postoperative complications, reintervention and self-reported incontinence. Logistic regression analyses were performed for assessing prognostic factors for fistula closure and postoperative complications. Ninety-two patients were included in the study; after a median follow-up of 19.3 months, fistula closure was achieved in 71% (n = 65) and in 89% (n = 82) after reinterventions. 46% (n = 42) reported persistent symptoms, although 83% of which (n = 32/42) had succesful fistula tract closure by clinical evaluation. One patient developed incontinency for gas. Smoking emerged as a significant risk factor for fistula closure failure, OR = 6.75, 95% CI = [1.65, 27.69], p = 0.030. Wound dehiscence was the most common complication, occuring in 25% (n = 23). Prolonged oral antibiotics demonstrated a significant protective effect against wound dehiscence, OR = 0.31, 95% CI = [0.10, 0.96], p = 0.036. The LIFT procedure is an efficient and safe treatment for complex perianal fistula. Patient satisfaction emerged as a crucial treatment goal, as patients can remain symptomatic after fistula closure. Emphasizing smoking cessation is integral to the treatment approach. The findings suggest prolonged antibiotic treatment as a potential preventive measure for wound dehiscence.
肛瘘治疗仍然是一项外科挑战。本研究聚焦于括约肌间瘘管结扎术（LIFT）治疗高位括约肌间型肛瘘的有效性和安全性，旨在确定成功及并发症的预后因素。对2013年1月至2021年1月期间在一家三级转诊医院接受LIFT手术的所有患者进行了回顾性病历审查。主要终点是经临床检查确认的瘘管闭合成功率。次要终点包括术后并发症、再次干预和自我报告的失禁情况。进行逻辑回归分析以评估瘘管闭合和术后并发症的预后因素。92例患者纳入研究；中位随访19.3个月后，71%（n = 65）的患者实现了瘘管闭合，再次干预后这一比例为89%（n = 82）。46%（n = 42）的患者报告有持续症状，不过其中83%（n = 32/42）经临床评估瘘管已成功闭合。1例患者出现气体失禁。吸烟是瘘管闭合失败的一个显著风险因素，OR = 6.75，95%CI = [1.65, 27.69]，p = 0.030。伤口裂开是最常见的并发症，发生率为25%（n = 23）。延长口服抗生素治疗对伤口裂开有显著的保护作用，OR = 0.31，95%CI = [0.10, 0.96]，p = 0.036。LIFT手术是治疗复杂性肛周瘘的一种有效且安全的方法。患者满意度成为一个关键的治疗目标，因为患者在瘘管闭合后仍可能有症状。强调戒烟是治疗方法中不可或缺的一部分。研究结果表明延长抗生素治疗是预防伤口裂开的一种潜在措施。
