Endosonograpy-confirmed long-term outcomes of ligation of the intersphincteric fistula tract procedure for complex perianal fistulas

Abstract

OBJECTIVE: As the short-term outcomes may overestimate the true success rates of sphincter-sparing techniques, and follow-up protocols that were reported based on clinical criteria do not ideally reflect real world outcomes associated with complex perianal fistulas (CPF), this study aimed to reveal clinically and three dimensional endosonograpy confirmed long-term outcomes and analyze the factors associated with recurrences of ligation of intersphincteric fistula tract (LIFT) procedure.

PATIENTS AND METHODS: A retrospective cross-sectional review was conducted for patients who underwent the LIFT procedure for complex perianal fistulas between October 2015 and February 2017. Cox proportional regression model was used to estimate the mean failure free survival rates and log-rank test was used to compare the outcome distributions for patients who healed vs presented with failure.

RESULTS: A total of 42 patients with the majority of males (n=34, %81), who underwent LIFT procedure for CPF were analyzed. None of patients were lost at follow-up. Endosonograpy-confirmed fistula types were high transsphincteric(n=35), horseshoe fistula (n=5) and suprasphicteric (n=2). After a median follow-up of 25.1 (15-36) months, the overall healing rate was 57.1%, which subsequently increased to 85.7% with a simple secondary intervention. Based on Cox regression analysis, previous perianal intervention was found to be independent risk factor for failure (p=0.025). Having prior perianal surgery significantly increased the risk of recurrence 6.7 times (OR:6,7 95% CI:1,9-24,1 p=0,003). Outcomes were confirmed by endoanal ultrasound for all patients.

CONCLUSIONS: Endoanal ultrasound confirmed long-term assessment of the LIFT procedure provides an acceptable success rate, especially when combined with secondary simple interventions, without impairment on continence for the complex perianal fistulas.