Comparative Study between Ligation of Trans-sphincteric Fistula Tract and Fistulectomy in Treatment of Fistula in Ano

Background: Treatment of trans-sphincteric fistulas with fistulectomy involves a large wound with risk of incontinence and recurrence. Procedure of Ligation of Inter-sphincteric Fistula Tract (LIFT) approach emerged recently and expected to provide more favorable outcomes and less risk of incontinence.
Objectives: This comparative study was done to evaluate operative and postoperative outcomes of LIFT procedure in comparison with traditional fistulectomy in treatment of trans-sphincteric fistulas.
Patients and methods: Study was carried out on 48 patients with trans-sphincteric fistulas assigned into 2 groups; group A treated with LIFT included 23 patients and group B treated with fistulectomy done in 25 patients.
Results: Mean operative time was significantly shorter in group A than in group B (p = 0.001). Postoperative pain means sores were significantly less in LIFT group; than in groups A and B respectively (p = 0.04), while hospital stay showed no statistical significance; in group A versus in group B (p= 0.25). The mean wound healing in LIFT group was significantly shorter than in fistulectomy group (p = 0.003). As regard postoperative complications in groups A and B, infection reported in 4 & 7 patients (17.3% & 28%), minor bleeding in 2 & 4 patients (8.6% & 16 %) respectively, no incontinence reported in group A and 3 patients shown temporary incontinence to flatus in group B. Overall recurrence was 31.2 % (15 patients); 6 patients (26.1 %) post-LIFT and 9 patients (36 %) post-fistulectomy includes failure of healing (3 post-LIFT and 5 post-fistulectomy), difference in recurrence was insignificant (p = 0.3).
Conclusion: LIFT procedure offers a shorter operative time, lower postoperative pain, faster wound healing and low incidence of incontinence in comparison to fistulectomy while recurrence rate was insignificantly different.