LIFT Presentation for ESS Congress
Transcript of LIFT Presentation for ESS Congress
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OUR “LIGATION OF INTERSPHINCTERIC FISTULA TRACT” EXPERIENCE FOR COMPLEX ANORECTAL FISTULAS: IS IT A PREFERABLE METHOD?
T. Yoldas§, E. Ekmekçigil§, C. Karaca§, T. Sezer§, C. Çalışkan§, E. Akgün§, M. Korkut§
§
Ege University Faculty of Medicine, Department of General Surgery
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Introduction and General Information
• Fistula in Ano– Difficult to manage– Difficult to succeed• Recurrence rates 0 to 30%• Incontinence rates 0 to 63%• Wide variation.. • Not sure what to do?
– Best operation of choice?
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Relevant Anatomy 1
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Relevant Anatomy 2
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Relevant Anatomy 3
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Relevant Anatomy 4
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Goodsall's rule
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Main Goal
“Healing the fistula while
avoiding recurrence and
incontinence”
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Complex Fistula
• Involving more than 30 – 50 % of external sphincter
• Anteriorly located fistula in females• Fistula with multiple tracts• Patient with incontinency due to fistula• Patients with Crohn’s disease• Recurrent fistula
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Surgery for Complex Fistula
Curretage and Fibrin
glue
Seton Ligation
Endorectal Mucozal
Flap
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L.I.F.T.
Ligation of Intersphincteric Fistula Tract
• Rojanasakul M.D. in 2006
• 18 patients with complex fistula
• 94,4% success rate
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Patients and Methods
• 11 patients with complex fistula– Exclusion criteria• Patients with Crohn’s disease• Recurrent fistula
• From November 2010 to April 2012 who underwent L.I.F.T.
• All patients were reevaluated with anamnesis and physical examination
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Surgery 1
• Regional anesthesia• Internal orifice localized with SF• Tract hanged with a metal probe• An intersphincteric 2cm incision made• Tract is localized and ligated and divided– From the closest portion to the internal orifice– With 2/0 polyglactin material
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Surgery 2
• Internal orifice sutured
• External orifice and remaining distal tract
is excised (core out)
• Intersphincteric space approximated
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Results
• 7 males, 3 females• 1 patient was lost to follow up• Mean age: 44.8• Mean follow up time: 13.7 months• Mean hospital stay: 1.5 days• Complete healing rate 80%• 20% had ongoing/recurrent symptoms• No wound complication• No incontinence
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Discussion 1
• Relatively easier
– Much easier than mucosal flapping
• Low recurrence rates
– Up to 63% with mucosal flaps
– Up to 84% with fibrin glue
• High success rates
– Original success rate reported 94.4%
– Our success rate 80%
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Discussion 2
• Comfortable for patient
– Seton technique lowers quality of life
– Possible need for a second operation
• Wide variety of application environments
– Can be applied to patients who were previously treated with
seton
• Easy to treat ongoing and/or recurrent disease
• Perfect preservation of sphincter functions
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Conclusion / Take home message
LIFT technique is a;» Successful» Easy to apply» Comfortable» Sphincter preserving
alternative to,» Seton technique» Mucosal flapping» Curettage and fibrin glue
for the treatment of complex anal fistulas.