Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6805
Revised: August 13, 2013
Accepted: August 17, 2013
Published online: October 28, 2013
Broadly, complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing, prevent recurrences and maintain continence. The risk of incontinence associated with treatment ranges from 10% to 57%. The objective of this manuscript is to review the current literature to date on the ligation of the intersphincteric fistula tract procedure (LIFT procedure) as a treatment option in these types of fistula. A search was conducted in Medline, PUBMED, EMBASE and ISI Web of Knowledge, and studies published from January 2009 to May 2013 were included. The primary outcomes were fistula healing rates, mean healing time and patient satisfaction with this surgical technique. Eighteen studies were included in this review. The total number of patients included was 592 (65% male). The median age reported was 42.8 years. The most common type of fistula included was transsphincteric (73.3% of cases). The mean healing rate reported was 74.6%. The risk factors for failure discovered were obesity, smoking, multiple previous surgeries and the length of the fistula tract. The mean healing time was 5.5 wk, and the mean follow-up period was 42.3 wk. The patient satisfaction rates ranged from 72% to 100%. No de novo incontinence developed secondary to the LIFT procedure. There is not enough evidence that variants in the surgical technique achieve better outcomes (Bio-LIFT, LIFT-Plug, LIFT-Plus). This review indicates that the LIFT procedure is primarily effective for transsphincteric fistulas with an overall fistula closure of 74.6% and has a low impact on fecal continence. This procedure produces better outcomes at the first surgical attempt.
Core tip: We review the current literature published until today about the ligation of intersphincteric fistula tract -procedure. The paper describes the different types of fistulas in which the technique has been used; the cure rates achieved; the reported recurrence rates; types of failures and morbidity related to it. The paper analyzes the prognostic factors for the success; describes the various modifications of the surgical technique and the results obtained with them. The manuscript classifies the types of failures and gives options for their proper treatments. With all these, it sets the achievements and limitations of the technique, with the scientific evidence available today.