Nisar A Chowdri1*, Salim Nazki2, Zamir Ahmad Shah3, Gowhar Aziz Bhat3, Fazl Q Parray3 and Rauf A Wani3
1Department of General and Minimally Invasive Surgery, Division of Colorectal, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
2Department of General Surgery, Sheri Kashmir Institute of Medical Sciences, India
3Department of Colorectal Surgery, Sheri Kashmir Institute of Medical Sciences, India
Background: A sphincter saving technique known as Ligation of Intersphincteric Fistula Tract (LIFT) has become popular for treatment of fistula-in-ano. This technique involves ligation and division of the fistula tract in the intersphincteric space without using any biological material. Aim: The aim of the study was to see the feasibility and results of LIFT technique in managing different types of fistula-in-ano and the postoperative complications and recurrence rates. Method: A prospective study conducted in the Department of Colorectal Surgery, a Division of General and Minimal Invasive Surgery, Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Srinagar over a period of 26 months. Patients with fistula-in-ano were enrolled for the study. Detailed history, clinical examination & evaluation were done as per the protocol. Patients were subjected to standard surgical treatment. LIFT was used where found to be feasible depending on type and nature of fistula. All patients were followed regularly and results analyzed statistically. Results: The LIFT technique seems to be safe and simple but our study revealed that only 38.2% cases of all fistula-in-ano could be treated by this technique. Procedure is difficult in patients having horse shoe fistula, non-location of internal opening or tract, scarring due to previous surgery multiple tracts, complex fistulas, abscesses, high fistula, curved and short tract. None of the patients had post-operative incontinence however 6.4% had post-operative infection and 12.9% had wound dehiscence. Recurrence was observed in only one patient. Most of the patients (77.41%) had less than 1 day stay in hospital post procedure. On satisfaction score, 67.74% patients who underwent LIFT technique were satisfied and 22.58% were non-satisfied. The median follows up was 17.6 months. Conclusion: The ligation of the intersphincteric fistula tract technique for fistula-in-ano surgery, which aims at total anal sphincter preservation is safe and easy to perform but has its demerits too. Further modifications and studies with large samples and longer follow up are needed to treat the complex fistulae and fistulas having multiple tracts and to make verdict on the technique.
Chowdri NA, Nazki S, Shah ZA, Bhat GA, Parray FQ, Wani RA. Ligation of Intersphincteric Fistula Tract (LIFT) for Fistula-in-Ano: Feasibility and Our Experience. Clin Surg. 2020; 5: 2817..