1. OUR “LIGATION OF INTERSPHINCTERIC
FISTULA TRACT” EXPERIENCE FOR COMPLEX
ANORECTAL FISTULAS: IS IT A PREFERABLE
METHOD?
T. Yoldas§, E. Ekmekçigil§, C. Karaca§, T. Sezer§, C. Çalışkan§,
E. Akgün§, M. Korkut§
§
Ege University Faculty of Medicine, Department of General Surgery

2. Introduction and General Information
• Fistula in Ano
– Difficult to manage
– Difficult to succeed
• Recurrence rates 0 to 30%
• Incontinence rates 0 to 63%
• Wide variation..
• Not sure what to do?
– Best operation of choice?

3. Relevant Anatomy 1

4. Relevant Anatomy 2

5. Relevant Anatomy 3

6. Relevant Anatomy 4

7. Goodsall's rule

8. Main Goal
“Healing the fistula while
avoiding recurrence and
incontinence”

9. Complex Fistula
• Involving more than 30 – 50 % of external
sphincter
• Anteriorly located fistula in females
• Fistula with multiple tracts
• Patient with incontinency due to fistula
• Patients with Crohn’s disease
• Recurrent fistula

10. Endorectal
Mucozal
Seton Flap
Ligation
Curretage
and Fibrin
glue
Surgery for Complex Fistula

11. L.I.F.T.
Ligation of Intersphincteric Fistula Tract
• Rojanasakul M.D. in 2006
• 18 patients with complex fistula
• 94,4% success rate

12. Patients and Methods
• 11 patients with complex fistula
– Exclusion criteria
• Patients with Crohn’s disease
• Recurrent fistula
• From November 2010 to April 2012 who
underwent L.I.F.T.
• All patients were reevaluated with anamnesis
and physical examination

13. Surgery 1
• Regional anesthesia
• Internal orifice localized with SF
• Tract hanged with a metal probe
• An intersphincteric 2cm incision made
• Tract is localized and ligated and divided
– From the closest portion to the internal orifice
– With 2/0 polyglactin material

16. Surgery 2
• Internal orifice sutured
• External orifice and remaining distal tract
is excised (core out)
• Intersphincteric space approximated

19. Results
• 7 males, 3 females
• 1 patient was lost to follow up
• Mean age: 44.8
• Mean follow up time: 13.7 months
• Mean hospital stay: 1.5 days
• Complete healing rate 80%
• 20% had ongoing/recurrent symptoms
• No wound complication
• No incontinence

20. Discussion 1
• Relatively easier
– Much easier than mucosal flapping
• Low recurrence rates
– Up to 63% with mucosal flaps
– Up to 84% with fibrin glue
• High success rates
– Original success rate reported 94.4%
– Our success rate 80%

21. Discussion 2
• Comfortable for patient
– Seton technique lowers quality of life
– Possible need for a second operation
• Wide variety of application environments
– Can be applied to patients who were previously treated with
seton
• Easy to treat ongoing and/or recurrent disease
• Perfect preservation of sphincter functions

22. Conclusion / Take home message
LIFT technique is a;
» Successful
» Easy to apply
» Comfortable
» Sphincter preserving
alternative to,
» Seton technique
» Mucosal flapping
» Curettage and fibrin glue
for the treatment of complex anal fistulas.