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Sphincter-sparing techniques for fistulas-in-ano.

E Pommaret1, P Benfredj1, D Soudan1

  • 1Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.

Journal of Visceral Surgery
|October 5, 2014
PubMed
Summary

Sphincter-saving techniques (SST) for anal fistulas offer alternatives to traditional fistulotomy, aiming to reduce incontinence. The Ligation of the Intersphincteric Fistula Tract (LIFT) procedure shows promising success rates without compromising continence.

Keywords:
Advancement flapAnal fistulaAutologous stem cellsClipFibrin glueIncontinencePlugSphincter saving

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Area of Science:

  • Colorectal Surgery
  • Gastroenterology
  • Surgical Innovation

Background:

  • Anal fistulas necessitate surgical intervention for definitive cure.
  • Fistulotomy, while effective, poses a risk of postoperative incontinence.
  • Sphincter-saving techniques (SST) aim to mitigate incontinence by avoiding sphincter division.

Purpose of the Study:

  • To review and evaluate the efficacy of various sphincter-saving techniques for anal fistula treatment.
  • To highlight the Ligation of the Intersphincteric Fistula Tract (LIFT) as a recent SST.
  • To assess the success rates and continence outcomes of LIFT compared to other SSTs.

Main Methods:

  • Review of existing literature on anal fistula surgical treatments.
  • Focus on sphincter-saving techniques including flap advancement, glue injection, collagen plugs, and LIFT.
  • Analysis of reported success rates and postoperative incontinence associated with each technique.

Main Results:

  • Sphincter-saving techniques generally have lower success rates than fistulotomy.
  • The Ligation of the Intersphincteric Fistula Tract (LIFT) procedure has demonstrated attractive success rates (70-95%) in several studies.
  • LIFT shows potential for treating anal fistulas without causing postoperative incontinence.

Conclusions:

  • Ligation of the Intersphincteric Fistula Tract (LIFT) is a promising sphincter-saving technique for anal fistulas.
  • While methodological quality varies, LIFT offers a viable option to preserve continence.
  • Further research may be needed to solidify the long-term efficacy of LIFT and other novel SSTs.