The abstract has been accepted for oral presentation at ESCP’s 7th Scientific and Annual Meeting in 2012.
Ligation of the intersphincteric fistula tract in low transsphincteric fistulae: a new technique to avoid fistulotomy
Version of Record online: 25 APR 2013
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 5, pages 587–591, May 2013
How to Cite
van Onkelen, R. S., Gosselink, M. P. and Schouten, W. R. (2013), Ligation of the intersphincteric fistula tract in low transsphincteric fistulae: a new technique to avoid fistulotomy. Colorectal Disease, 15: 587–591. doi: 10.1111/codi.12030
- Issue online: 25 APR 2013
- Version of Record online: 25 APR 2013
- Accepted manuscript online: 13 SEP 2012 10:39AM EST
- Received 27 June 2012; accepted 3 August 2012; Accepted Article online 13 October 2012
- Ligation of the intersphincteric fistula tract;
- low transsphincteric fistula;
- faecal continence
Aim To date fistulotomy is still the treatment of choice for patients with a transsphincteric fistula passing through the lower third of the external anal sphincter, because it is a simple, effective and safe procedure with a minimal risk of incontinence. However, data suggest that the risk of impaired continence following division of the lower third of the external anal sphincter is not insignificant, especially in female patients with an anterior fistula and patients with diminished anal sphincter function. It has been shown that ligation of the intersphincteric fistula tract (LIFT) is a promising sphincter-preserving technique. Therefore, we questioned whether LIFT could replace fistulotomy in patients with a low transsphincteric fistula.
Method A consecutive series of 22 patients with a low transsphincteric fistula of cryptoglandular origin underwent LIFT. Continence scores were determined using the Rockwood Fecal Incontinence Severity Index.
Results Median follow-up was 19.5 months. Primary healing was observed in 18 (82%) patients. In the four patients without primary healing, the transsphincteric fistula was converted into an intersphincteric fistula. These patients underwent subsequent fistulotomy with preservation of the external anal sphincter. The overall healing rate was 100%. Six months after surgery, the median incontinence score was not changed significantly.
Conclusion Low transsphincteric fistulae can be treated successfully by LIFT, without affecting faecal continence. Division of the lower part of the external anal sphincter is no longer necessary in the treatment of low transsphincteric fistulae, which is essential for patients with compromised anal sphincters.