Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: Systematic review and meta-analysis

Kwang Dae Hong, S. Kang, S. Kalaskar, S. D. Wexner

Research output: Contribution to journalReview article

56 Citations (Scopus)

Abstract

Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5 %, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.

Original languageEnglish
Pages (from-to)685-691
Number of pages7
JournalTechniques in Coloproctology
Volume18
Issue number8
DOIs
Publication statusPublished - 2014 Jan 1

Fingerprint

Rectal Fistula
Fistula
Ligation
Meta-Analysis
Drainage
Intraoperative Complications
PubMed
Case-Control Studies
Databases

Keywords

  • Anal fistula
  • Ligation of intersphincteric fistula tract
  • Sphincter-preserving procedure

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula : Systematic review and meta-analysis. / Hong, Kwang Dae; Kang, S.; Kalaskar, S.; Wexner, S. D.

In: Techniques in Coloproctology, Vol. 18, No. 8, 01.01.2014, p. 685-691.

Research output: Contribution to journalReview article

@article{1ce3ca14b3c94cbfb12bec5ed7549496,
title = "Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: Systematic review and meta-analysis",
abstract = "Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5 {\%}, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.",
keywords = "Anal fistula, Ligation of intersphincteric fistula tract, Sphincter-preserving procedure",
author = "Hong, {Kwang Dae} and S. Kang and S. Kalaskar and Wexner, {S. D.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s10151-014-1183-3",
language = "English",
volume = "18",
pages = "685--691",
journal = "Techniques in Coloproctology",
issn = "1123-6337",
publisher = "Springer-Verlag Italia",
number = "8",

}

TY - JOUR

T1 - Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula

T2 - Systematic review and meta-analysis

AU - Hong, Kwang Dae

AU - Kang, S.

AU - Kalaskar, S.

AU - Wexner, S. D.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5 %, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.

AB - Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5 %, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.

KW - Anal fistula

KW - Ligation of intersphincteric fistula tract

KW - Sphincter-preserving procedure

UR - http://www.scopus.com/inward/record.url?scp=84905904558&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905904558&partnerID=8YFLogxK

U2 - 10.1007/s10151-014-1183-3

DO - 10.1007/s10151-014-1183-3

M3 - Review article

C2 - 24957361

AN - SCOPUS:84905904558

VL - 18

SP - 685

EP - 691

JO - Techniques in Coloproctology

JF - Techniques in Coloproctology

SN - 1123-6337

IS - 8

ER -