PMID- 22974372
OWN - NLM
STAT- MEDLINE
DCOM- 20140123
LR  - 20130426
IS  - 1463-1318 (Electronic)
IS  - 1462-8910 (Linking)
VI  - 15
IP  - 5
DP  - 2013 May
TI  - Ligation of the intersphincteric fistula tract in low transsphincteric fistulae: 
      a new technique to avoid fistulotomy.
PG  - 587-91
LID - 10.1111/codi.12030 [doi]
AB  - AIM:   To date fistulotomy is still the treatment of choice for patients with a 
      transsphincteric fistula passing through the lower third of the external anal 
      sphincter, because it is a simple, effective and safe procedure with a minimal 
      risk of incontinence. However, data suggest that the risk of impaired continence 
      following division of the lower third of the external anal sphincter is not 
      insignificant, especially in female patients with an anterior fistula and 
      patients with diminished anal sphincter function. It has been shown that ligation 
      of the intersphincteric fistula tract (LIFT) is a promising sphincter-preserving 
      technique. Therefore, we questioned whether LIFT could replace fistulotomy in 
      patients with a low transsphincteric fistula. METHOD: A consecutive series of 22 
      patients with a low transsphincteric fistula of cryptoglandular origin underwent 
      LIFT. Continence scores were determined using the Rockwood Fecal Incontinence 
      Severity Index. RESULTS:   Median follow-up was 19.5months. Primary healing was 
      observed in 18 (82%) patients. In the four patients without primary healing, the 
      transsphincteric fistula was converted into an intersphincteric fistula. These 
      patients underwent subsequent fistulotomy with preservation of the external anal 
      sphincter. The overall healing rate was 100%. Six months after surgery, the 
      median incontinence score was not changed significantly. CONCLUSION:   Low 
      transsphincteric fistulae can be treated successfully by LIFT, without affecting 
      faecal continence. Division of the lower part of the external anal sphincter is 
      no longer necessary in the treatment of low transsphincteric fistulae, which is 
      essential for patients with compromised anal sphincters.
CI  - (c) 2012 The Authors. Colorectal Disease (c) 2012 The Association of Coloproctology 
      of Great Britain and Ireland.
FAU - van Onkelen, R S
AU  - van Onkelen RS
AD  - Department of Surgery Immunology, Erasmus MC, University Medical Center, 
      Rotterdam, The Netherlands.
FAU - Gosselink, M P
AU  - Gosselink MP
FAU - Schouten, W R
AU  - Schouten WR
LA  - eng
PT  - Journal Article
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
SB  - IM
CIN - Colorectal Dis. 2013 May;15(5):596-7. PMID: 23617846
MH  - Adolescent
MH  - Adult
MH  - Anal Canal/pathology/*surgery
MH  - Fecal Incontinence/*etiology
MH  - Female
MH  - Humans
MH  - Ligation/adverse effects
MH  - Male
MH  - Middle Aged
MH  - *Organ Sparing Treatments/adverse effects
MH  - Rectal Fistula/*surgery
MH  - Severity of Illness Index
MH  - Young Adult
EDAT- 2012/09/15 06:00
MHDA- 2014/01/24 06:00
CRDT- 2012/09/15 06:00
PHST- 2012/09/15 06:00 [entrez]
PHST- 2012/09/15 06:00 [pubmed]
PHST- 2014/01/24 06:00 [medline]
AID - 10.1111/codi.12030 [doi]
PST - ppublish
SO  - Colorectal Dis. 2013 May;15(5):587-91. doi: 10.1111/codi.12030.