Comparative study between fistulectomy and ligation of intersphincteric fistula tract for uncomplicated fistula in ano
DOI:
https://doi.org/10.61581/mjsp.v7i01.344Keywords:
Fistula in ano, Fistulectomy, Ligation of intersphincteric fistula tract, postoperative painAbstract
Objective: To do comparison of fistulectomy versus ligation of intersphincteric fistula in patients presenting with uncomplicated fistula in ano.
Methodology: Quasi-experimental study was conducted at department of General Surgery, Combined Military Hospital Rawalpindi from Apr 2023 till Mar 2024. A total of 82 patients of both sexes, diagnosed with uncomplicated fistula-in-ano, were allocated into two equal groups of 41Group A patients received a fistulectomy, whereas Group B patients were treated using the ligation of intersphincteric fistula tract (LIFT) method. The operation timings were documented in both groups. Patients were followed up at weekly intervals till 8 weeks for documentation of healing and any complications.
Results: The Mean age of the patients was 35.9± 8.4 years. In Group A, mean healing time was 7.1±0.9 weeks, compared to 3.9±0.9 weeks in Group B; this difference was statistically significant (p<0.001). The mean pain score according to VAS was 3.5±1.0 in Group A versus 2.8±1.1 in Group B respectively. The difference between the two groups was significant (p=0.004).
Conclusion: Ligation of intersphincteric fistula was better than fistulectomy in patients presenting with uncomplicated fistula-in-ano in terms of early healing and lesser severity of pain postoperatively.
Downloads
References
1. Charalampopoulos A, Papakonstantinou D, Bagias G, Nastos K, Perdikaris M, Papagrigoriadis S. Surgery of simple and complex anal fistulae in adults: a review of the literature for optimal surgical outcomes. Cureus. 2023;15(3):e35888. https://doi.org/10.7759/cureus.35888.
2. Dekker L, Zimmerman DDE, Smeenk RM, Schouten R, Han-Geurts IJM. Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands. Tech Coloproctol. 2021;25(6):709-19. https://doi.org/10.1007/s10151-021-02446-3.
3. Sarveazad A, Bahardoust M, Shamseddin J, Yousefifard M. Prevalence of anal fistulas: a systematic review and meta-analysis. Gastroenterol Hepatol Bed Bench. 2022 Winter;15(1):1-8. https://doi.org/10.22037/ghfbb.vi.2365.
4. Virji SN, Khan S. Ligation of intersphincteric fistula tract: A retrospective, single centre, individual surgeons' experience for the management of complex fistula in ano. J Pak Med Assoc. 2024;74(9):1603-7. https://doi.org/10.47391/JPMA.10181.
5. Khan S, Kotcher R, Herman P, Wang L, Tessler R, Cunningham K, et al. Predictors of recurrence and long-term patient reported outcomes following surgical repair of anal fistula, a retrospective analysis. Int J Colorectal Dis. 2024;39(1):37. https://doi.org/10.1007/s00384-024-04602-1.
6. Hariprasad CP, Kumar A, Kumar M, Kumar M, Paswan SS, Rohit G,et al. The efficacy of Ksharsutra, Fistulectomy and Ligation of Intersphincteric Fistula Tract (LIFT) procedure in management of Fistula in ano a prospective observational study. BMC Surg. 2023;23(1):70. https://doi.org/10.1186/s12893-023-01969-w.
7. Bhat S, Xu W, Varghese C, Dubey N, Wells CI, Harmston C, et al. Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis. Tech Coloproctol. 2023;27(10):827-45. https://doi.org/10.1007/s10151-023-02845-8.
8. van Oostendorp JY, Verkade C, Han-Geurts IJM, van der Mijnsbrugge GJH, Wasowicz-Kemps DK, Zimmerman DDE. Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence. BJS Open. 2024;8(3):zrae055. https://doi.org/10.1093/bjsopen/zrae055.
9. Hiremath SCS, Patil R. Fistulotomy versus fistulectomy for fistula-in-ano: a randomized prospective study. Surg J (N Y). 2022;8(4):e336-40. https://doi.org/10.1055/s-0042-1758633.
10. Rydzek M, Ciesielski P, Diuwe P. The results of high-position anal fistula treatment using the LIFT (ligation of intersphincteric fistula tract) procedure. A retrospective, single-center study. Pol PrzeglChir. 2021;93(4):41-5. https://doi.org/10.5604/01.3001.0014.8769.
11. Malik T, Nadeem N, Aslam MN. LIFT vs fistulectomy: aretrospectivecohortstudy. Pak J Med Health Sci. 2022;16(09):55. https://doi.org/10.53350/pjmhs2216955.
12. Saeed AB, Kashf B, Nadeem T, Iqbal J. Comparison of outcome in fistulectomy and Ligation of intersphinteric tractin patients of fistula in ano. Professional Med J. 2022;29(8):1137-41. https://doi.org/10.29309/TPMJ/2022.29.08.6934/
13. Al Sebai OI, Ammar MS, Mohamed SH, El Balshy MA. Comparative study between intersphinecteric ligation of perianal fistula versus conventional fistulotomy with or without seton in the treatment of perianal fistula: A prospective randomized controlled trial. Ann Med Surg (Lond). 2020 Dec 18;61:180-4. https://doi.org/10.1016/j.amsu.2020.12.014.
14. Sohrabi M, Bahrami S, Mosalli M, Khaleghian M, Obaidinia M. Perianal fistula; from etiology to treatment - a review. Middle East J Dig Dis. 2024;16(2):76-85. https://doi.org/10.34172/mejdd.2024.373.
15. Ji L, Zhang Y, Xu L, Wei J, Weng L, Jiang J. Advances in the treatment of anal fistula: a mini-review of recent five-year clinical studies. Front Surg. 2021;7:586891. https://doi.org/10.3389/fsurg.2020.586891.
16. Dong X, Jia Z, Yu B, Zhang X, Xu F, Tan L. Effect of intersphincteric fistula tract ligation versus anal fistulectomy on pain scores and serum levels of vascular endothelial growth factor and interleukin-2 in patients with simple anal fistulas. J Int Med Res. 2020;48(9):300060520949072. https://doi.org/10.1177/0300060520949072.
17. Sirikurnpiboon S. The risk factors for failure and recurrence of LIFT procedure for fistula in ano. Turk J Surg. 2023;39(1):27-33. https://doi.org/10.47717/turkjsurg.2023.5807.
18. Vander Mijnsbrugge GJH, Felt-Bersma RJF, Ho DKF, Molenaar CBH. Perianal fistulas and the lift procedure: results, predictive factors for success, and long-term results with subsequent treatment. Tech Coloproctol. 2019;23(7):639-47. https://doi.org/10.1007/s10151-019-02023-9.
19. Rezk M, Emile SH, Fouda EY, Khaled N, Hamed M, Omar W, et al. Ligation of intersphincteric fistula tract (LIFT) with or without injection of bone marrow mononuclear cells in the treatment of trans-sphincteric anal fistula: a randomized controlled trial. J Gastrointest Surg. 2022;26(6):1298-306. https://doi.org/10.1007/s11605-022-05316-x.
20. Schäfer AO. Perianale entzündliche Erkrankungen : Klassifikation und Bildgebung [Perianal inflammatory diseases: Classification and imaging]. Radiologe 2018;58(4):344-354. https://doi.org/10.1007/s00117-018-0368-6
Published
Issue
Section
License
Copyright (c) 2026 Afsa Nayyar, Abdullah Sher Kakar, Waqas Ahmed, Imran Ashraf , Deepak Doltani, Hamna Anwar
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
