Ligation of intersphincteric fistula tract and its modification: Results from treatment of complex fistula

Table 1 Assessment of clinical continence grading

Category	Description
A	Continent of solid and liquid stools and flatus (i.e., normal continence)
B	Continent of solid and usually liquid stools but not flatus (no fecal leakage)
C	Acceptable continence for solid stool but no control over liquid stool or flatus (intermittent fecal leakage)
D	Continued fecal leakage

Reproduced from Browning et al[26].

Table 2 Patient demographic data

	LIFT	LIFT plus	P vaule
Patients	21	20
Age average	43.95 ± 12.35	37.45 ± 10.58
(mean ± SD, yr) (range)	(23-71)	(21-54)	0.650
Sex
Male	17	14	0.326
Female	4	6
Underlying disease	0	0
BMI (kg/m2, mean ± SD)	24.20 ± 4.62	23.08 ± 5.38	0.480
Prior fistula operation	0	0
Fistula type			0.365
High-transsphincteric	19	14
Horseshoe-transsphincteric	1	3
Suprasphincteric	0	1
Low-transsphincteric	1	2
Preoperative incontinence
Clinical	A	A
WIS	0	0
Timing from diagnosis of fistula-in- ano to operation (median, wk) (range)	16 (4-52)	18 (4-150)	0.547

BMI: Body mass index; WIS: Wexner incontinence score; LIFT: Ligation of intersphincteric fistula tract.

Table 3 Results

	LIFT	LIFT PLUS	P vaule
Operative time	37.67 ± 17.40	44.00 ± 14.29	0.400
(mean ± SD, min) (range)	(20-75)	(25-90)
Healing rate	81%	85%	0.529
Postoperative incontinence
Clinical	A	A
WIS	0	0
Postoperative complications			0.520
Headache	0	0
Urinary retention	0	0
Bleeding (minor)	0	1
Anal fissure	1	1
Difficulty in defecating	0	0
Wound healing time (median, wk )	4	4	0.262
Follow up (median, wk) (range)	18 (12-22)	20 (12-24)
Time to recurrence (median , wk)	10	12	0.354
Recurrence cases n (%)
High-transsphincteric	4 (19)	3 (15)
Horseshoe-transsphincteric	0 (0)	0 (0)
Suprasphincteric	0 (0)	0 (0)
Anterior low-transsphincteric in females	0 (0)	0 (0)
Re-operation	3	3

WIS: Wexner incontinence score.

Table 4 Comparative factors of recurrence (mean ± SD)

Factor	Heal (n = 34)	Recurrence (n = 7)	P vaule
Age, yr	41.35 ± 12.00	38.00 ± 11.43	0.502
BMI, kg/m2	22.0 ± 3.9	30.54 ± 3.54	< 0.001
Timing from diagnosis of fistula-in-ano to operation (median, wk) (range)	16 (4-150)	16 (4-110)	0.985

Table 5 Overall LIFT success rate

Author, year	Successrate	Patient	Follow upperiod	Incontinencerate
Rojanasakul et al[10], 2007	94%	17	4 wk	0
Bleier et al[13], 2010	57%	39	NA	NA
Shanwani et al[14], 2010	77%	45	9 mo	0
Tan et al[15], 2011	78%	93	23 wk	NA
Sileri et al[16], 2011	83%	18	4 mo	Same as preoperative
Ooi et al[18], 2012	68%	25	22 wk	0
Wallin et al[20], 2012	57%	93	19 mo	NA
Abcarian et al[21], 2012	74%	40	18 wk	NA
van Onkelen et al[36], 2012	82%	22	19.5 mo	0

NA: Not available.