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Background <p>Transsphincteric anal fistula is a common and challenging diagnosis for patients and surgeons alike. Ligation of the intersphincteric fistula tract (LIFT) following non-cutting seton placement represents an established definitive treatment with many technical variations. Unfortunately, up to 53% of attempted LIFTs fail. We aim to describe a modified LIFT approach and evaluate outcomes at our institution.</p> Methods <p>Thirty-two patients from 2021 to 2024 underwent the modified LIFT approach which included the offsetting of the transected fistula ends with interposing muscle plication, along with closure of the internal opening, and wide excision of the external opening. Retrospective chart review was performed to assess rates of primary wound healing, complications, recurrence, and incontinence. Recurrences were grouped into three types: type&#xa0;I, sinus tract or recurrent abscess without an internal opening; type&#xa0;II, conversion to an intersphincteric fistula; and type&#xa0;III, transsphincteric recurrence.</p> Results <p>The majority of patients were male (69%) with a mean age of 44&#xa0;years and mean BMI 31.6&#xa0;kg/m<sup>2</sup>. Median operative time was 88&#xa0;min. Primary healing rate was 94%. Median healing period was 7 (range 4–16) weeks. Of the 10 recurrences, (5 type&#xa0;I, 5 type&#xa0;II, and 0 type&#xa0;III), median time to recurrence was 6&#xa0;months after the primary wound healed. No patients experienced any postoperative incontinence or urinary retention.</p> Conclusions <p>In this cohort of patients with transsphincteric fistulas undergoing the LIFT procedure, the addition of offsetting muscle plication effectively limited transsphincteric recurrence. Further investigation is warranted to directly compare this LIFT adaptation to previously published literature.</p>

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A modified LIFT approach of offsetting sphincter muscle plication aimed at decreasing recurrence rates: a single-center retrospective review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月28日

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  • A. Troester,
  • J. Frebault,
  • E. Von Der Marwitz,
  • E. Arsoniadis,
  • S. M. Goldberg,
  • P. Goffredo,
  • C. Jahansouz

摘要

Background

Transsphincteric anal fistula is a common and challenging diagnosis for patients and surgeons alike. Ligation of the intersphincteric fistula tract (LIFT) following non-cutting seton placement represents an established definitive treatment with many technical variations. Unfortunately, up to 53% of attempted LIFTs fail. We aim to describe a modified LIFT approach and evaluate outcomes at our institution.

Methods

Thirty-two patients from 2021 to 2024 underwent the modified LIFT approach which included the offsetting of the transected fistula ends with interposing muscle plication, along with closure of the internal opening, and wide excision of the external opening. Retrospective chart review was performed to assess rates of primary wound healing, complications, recurrence, and incontinence. Recurrences were grouped into three types: type I, sinus tract or recurrent abscess without an internal opening; type II, conversion to an intersphincteric fistula; and type III, transsphincteric recurrence.

Results

The majority of patients were male (69%) with a mean age of 44 years and mean BMI 31.6 kg/m2. Median operative time was 88 min. Primary healing rate was 94%. Median healing period was 7 (range 4–16) weeks. Of the 10 recurrences, (5 type I, 5 type II, and 0 type III), median time to recurrence was 6 months after the primary wound healed. No patients experienced any postoperative incontinence or urinary retention.

Conclusions

In this cohort of patients with transsphincteric fistulas undergoing the LIFT procedure, the addition of offsetting muscle plication effectively limited transsphincteric recurrence. Further investigation is warranted to directly compare this LIFT adaptation to previously published literature.