Long-term outcomes in patients after ligation of the intersphincteric fistula tract

Ligation of the intersphincteric fistula tract (LIFT) to treat transsphincteric fistulae has yielded varied but promising results. However, it has been shown that long-term follow-up (> 250 days) is vital to obtain the correct surgical outcome. Here, we present the long-term results of patients undergoing the LIFT procedure at Herlev Hospital, Denmark.

The study was based on a retrospective chart review of 65 consecutive patients who underwent the LIFT procedure for transsphincteric fistula-in-ano in 2011-2015.

At the first follow-up, at a median 50 (interquartile range (IQR): 29-92) days, there were 28 recurrences of which 17 were transsphincteric. At the long-term follow-up, a median of 274 (IQR: 162-573) days, 16 patients (ten of whom were asymptomatic at the first follow-up) presented with a recurrence, of which seven were transsphincteric; 27 patients (42%) showed complete fistula healing following their initial LIFT surgery. Another 29 patients presented complete healing after repeated surgical treatment (additional LIFT, advancement flap and/or simple incision/fistulotomy), yielding a positive outcome in 86% of our patients.

The present study shows that the LIFT procedure is a viable treatment option for transsphincteric fistulae. Furthermore, a second LIFT procedure is a plausible option for recurrent transsphincteric fistulae. In the case of recurrence, the fistula was frequently downgraded to a more benign intersphincteric variant. The study supports previous findings showing that long-term follow-up is required to successfully measure the outcome of LIFT surgery.

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