LONG-TERM OUTCOMES OF LIGATION OF INTERSPHINCTERIC FISTULA TRACT FOR COMPLEX FISTULA-IN-ANO: MODIFIED OPERATIVE PROCEDURE EXPERIENCE

ABSTRACT Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.摘要 背景：复杂肛瘘（complex fistula-in-ano）因复发率高且易引发肛门失禁，其治疗极具挑战性且至关重要。括约肌间瘘管结扎术（Ligation of the Intersphincteric Fistula Tract, LIFT）作为一种可避免肛门失禁的新型术式，其成功率波动于57%~94.4%。目的：评估改良括约肌间瘘管结扎术（改良LIFT术）治疗复杂肛瘘的长期临床疗效。方法：对62例复杂肛瘘患者进行回顾性分析，所有患者均接受改良LIFT术式治疗，具体操作包括：于肛管皮肤做弧形切口，于瘘管周围实施荷包缝合，并以隧道法切除残余瘘管；所有患者随访时长均超过1年。对比分析患者术前一般状况、术后疗效及肛门功能。结果：受试者中位年龄为34岁，其中男性43例（占比69.4%）。41例（66.1%）为高位经括约肌肛瘘，4例（6.5%）为高位括约肌间肛瘘，女性患者中17例（27.4%）为前位肛瘘。中位随访时长为24.5个月（范围12~51个月）。随访结束时总体治疗成功率为83.9%（52/62）。术前及术后3个月的肛肠压力检测与佛罗里达克利夫兰诊所粪便失禁评分（Cleveland Clinic Florida Fecal Incontinence, CCF-FI）均未出现显著变化。结论：相较于传统LIFT术，改良LIFT术可显著降低复杂肛瘘术后失败及复发率，且长期疗效可控。