Patterns of Recurrence/Persistence of Cryptoglandular Anal Fistula After the LIFT Procedure. Long-Term Observational Study

• Published in: Cirugia española (English ed.) 2017-08, Vol.95 (7), p.385-390
• Main Authors: Placer Galán, Carlos, Lopes, Claudia, Múgica, José Andrés, Saralegui, Yolanda, Borda, Nerea, Enriquez Navascues, José M.
• Format: Article
• Language: English
• Subjects: Anal fistula; Fístula anal; LIFT procedure; Operación de LIFT; Recidiva; Recurrence
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2017.09.001

To study the recurrence/persistence rate of complex cryptoglandular anal fistula after the LIFT procedure and analyze the patterns of recurrence/persistence. Observational study of patients with transe-sphincteric or supra-sphincteric anal fistula treated using the LIFT procedure from December 2008 to April 2016. Variables studied included clinical characteristics, surgical technique and results. Clinical cure was defined and imaging studies were used in doubtful cases. Wexner's score was used for continence evaluation. The minimum follow-up time was one year. A total of 55 patients were operated on: 53 with a trans-sphincteric fistula and 2 supra-sphincteric. There were 16 failures (29%): 7 complete fistulas (original), 6 intersphincteric (downstage), and 3 external residual tracts. A posterior location and complexity of the tract were risk factors for recurrence/persistence. The presence of a seton did not improve results. No case presented decrease of continence (Wexner 0). Nine patients presented minor complications (9%): 4 intersphincteric wounds with delayed closure and one external hemorrhoidal thrombosis. The median time to closure of the external opening was 5 weeks (IR 2–6). Intersphincteric wounds closed in 4–8 weeks. In our experience, the LIFT technique is a safe and reproducible procedure with low morbidity, no repercussion on continence and a success rate over 70%. There are 3 types of recurrence: the intersphincteric fistula, the original fistulatula (trans- or supra-sphincteric) and the residual external tract. Considering the types of recurrence, only 12.7% of patients need more complex surgery to solve their pathology. The rest of the recurrences/persistence was solved by simple procedures (fistulotomy in intersphincteric forms and legrado in residual tracts). Valorar la recidiva/persistencia de la fístula anal compleja tras cirugía de tipo LIFT y analizar los patrones de recurrencia/persistencia. Estudio observacional de pacientes afectos de fístula anal transesfinteriana o supraesfinteriana tratada mediante la técnica LIFT durante el periodo diciembre de 2008-abril de 2016. Se analizan las características clínicas, la técnica quirúrgica y su resultado. Se define la curación clínica y se emplean pruebas de imagen en casos de duda. Se utiliza la escala Wexner para el estudio de la continencia. El tiempo mínimo de seguimiento ha sido de un año. Un total de 55 pacientes fueron intervenidos: 53 con fístula transesfinteriana y 2 supraesfinte