Effect of Ligation of Intersphincteric Fistula Tract Versus Anal Fistulotomy in Patients with Anal Fistulas

Abstract

Rambhupal Choudary*, Rakesh R, Saikalyan Guptha, Ravikumar H, Manikanta L and Karthik HS

Background: Fistula-in-ano is one of the most common anal conditions, treatment of which remains challenging to date.

Aims and objectives: The present study aims to compare outcomes of the LIFT (Ligation of Inter sphincteric Fistula Tract) and Fistulotomy at a tertiary care centre.

• Operation time,

• Post-operative pain,

• Recurrence,

• Anal incontinence

Materials and methods: A prospective study was carried out among 124 subjects attending the Department of General Surgery, VIMS and RC, Bangalore over a period of 18 months. Patients of either sex diagnosed with anal fistula were included in the study. Patients with recurrent fistulas, following trauma, Crohn’s disease, TB, actinomycosis and malignancy were excluded.

Results: Among 124 patients, 62 underwent the LIFT procedure while the other 62 patients underwent conventional fistulotomy. The average operating time for fistulotomy was significantly shorter at 21.15 minutes as compared to 32.35 minutes for LIFT (P<0.01). The average healing time was 15.27 days for LIFT whereas it was 47.77 days for fistulotomy (P<0.01). Pain on POD1 (Post-Operative Delirium) was 2.55 and 3.69 VAS (Visual Analog Scale) (P<0.01) in LIFT and fistulectomy respectively. There was no significant decrease in postoperative continence in both group.

Conclusion: LIFT is an effective sphincter saving procedure for fistula-in-ano with shorter healing time, early healing and less postoperative pain with an improved quality of life.