Does Treatment of Fistula-in-Ano by Ligation of Intersphincteric Fistula Tract Offer any Advantage over Standard Fistulectomy or Fistulotomy? PC01-PC04
Dr. Pallavi V Ayyar,
30, Godavari, Chheda Nagar, Chembur, Mumbai-400089, Maharashtra, India.
Introduction: Standard surgical treatment of trans-sphincteric fistulae by fistulectomy or fistulotomy has a morbidity of leaving a large perianal wound which needs prolonged care and has risk of incontinence and recurrence. Ligation of Intersphincteric Fistula Tract (LIFT) technique for fistula-in-ano has been reported to have less morbidity and recurrence.
Aim: To assess if the use of LIFT technique for the treatment of trans-sphincteric fistulae offers any advantage over standard fistulectomy or fistulotomy technique.
Materials and Methods: The prospective comparative study was carried out at Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India, after obtaining approval from the Institutional Ethics Committee. Sixty patients of trans-sphincteric fistula of cryptoglandular origin undergoing either LIFT or fistulectomy/fistulotomy were included and prospectively observed for operative time, postoperative pain, hospital stay, time taken for wound healing, incontinence and early recurrence (within three months of the operation). Statistical analysis was done by unpaired t-test and chi-square test using SAS® software.
Results: Patients operated by LIFT showed significantly shorter operative time (mean of 32.50 minutes vs. 40.17 minutes) and hospital stay (mean of 1.64 days vs. 2.53 days), decreased severity of pain and faster wound healing (mean 5.74 weeks vs. 6.89 weeks) compared to patients undergoing fistulectomy/fistulotomy. Though more patients had recurrence in the LIFT group (five patients in LIFT vs. three patients in fistulotomy/fistulectomy) this difference was not statistically significant. There was no incidence of incontinence (temporary or permanent) in patients of LIFT while three patients of fistulectomy had temporary flatus incontinence.
Conclusion: LIFT offers the benefit of a shorter operative time, decreased postoperative pain, shorter hospital stay and faster wound healing with very low incidence of incontinence compared to fistulectomy or fistulotomy with a recurrence rate not significantly different from it.