PMID- 31317361 OWN - NLM STAT- MEDLINE DCOM- 20200330 LR - 20200330 IS - 1128-045X (Electronic) IS - 1123-6337 (Print) IS - 1123-6337 (Linking) VI - 23 IP - 7 DP - 2019 Jul TI - Perianal fistulas and the lift procedure: results, predictive factors for success, and long-term results with subsequent treatment. PG - 639-647 LID - 10.1007/s10151-019-02023-9 [doi] AB - BACKGROUND: Treatment of a perianal fistula is difficult due to the risk of fecal incontinence and recurrence. The ligation of intersphincteric tract (LIFT) procedure is a sphincter-saving procedure associated with success rates ranging from 57 to 94%. The aim of our study was to find predictors for a favorable outcome of the LIFT procedure, evaluation of postoperative fecal incontinence, quality of life, and subsequent treatment with long-term follow-up. METHODS: This study was performed in patients who underwent LIFT between 2013 and 2015 at our institution. Their medical data were retrieved from the electronic patient files. The fistula characteristics were described by physical examination, three-dimensional endoanal ultrasound, and perioperative evaluation. Recurrence rate, postoperative fecal incontinence, and quality of life were assessed with the Patient-Reported Outcome Measurement (PROM). Thirty-two months later, long-term follow-up including subsequent procedures was evaluated. RESULTS: Forty-five patients [17 men, mean age 40 years (range 24-67 years)] were included. In 41 (84%) patients, the fistula was classified as complex; 32 (71%) were referrals with a history of previous fistula surgery. The initial success rate was 18 (40%). Only the height of the internal fistula opening (>/= 15 mm p < 0.03) was associated with recurrence. The LIFT procedure did not affect the occurrence of fecal incontinence or soiling. Recurrence showed a trend with a lower PROM (p = 0.07). Twenty-four months later, further surgery leads to cure in 34 (75%), asymptomatic fistulas in 7 (16%), and persisting active fistulas in 4 (9%) patients. CONCLUSIONS: Initial LIFT had a success rate of 40% and with subsequent surgical treatment 75%. Recurrence after LIFT is related to the height of the internal fistula opening and is associated with diminished quality of life. Continence was not affected by initial LIFT. FAU - Vander Mijnsbrugge, G J H AU - Vander Mijnsbrugge GJH AD - Proctos Kliniek, Bilthoven, The Netherlands. FAU - Felt-Bersma, R J F AU - Felt-Bersma RJF AUID- ORCID: 0000-0001-5786-7850 AD - Proctos Kliniek, Bilthoven, The Netherlands. rjf.felt@amsterdamumc.nl. AD - Department of Gastroenterology and Hepatology, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. rjf.felt@amsterdamumc.nl. FAU - Ho, D K F AU - Ho DKF AD - Department of Gastroenterology and Hepatology, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. FAU - Molenaar, C B H AU - Molenaar CBH AD - Proctos Kliniek, Bilthoven, The Netherlands. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20190717 PL - Italy TA - Tech Coloproctol JT - Techniques in coloproctology JID - 9613614 SB - IM MH - Adult MH - Aged MH - Anal Canal/*surgery MH - Fecal Incontinence/epidemiology/etiology MH - Female MH - Humans MH - Ligation/adverse effects/*methods MH - Male MH - Middle Aged MH - Patient Reported Outcome Measures MH - Postoperative Complications/epidemiology/etiology MH - Quality of Life MH - Rectal Fistula/*surgery MH - Recurrence MH - Treatment Outcome MH - Young Adult PMC - PMC6692447 OTO - NOTNLM OT - Anal ultrasound OT - Anorectal disease OT - LIFT OT - Perianal fistula COIS- All the authors declare that they have no conflict of interest. EDAT- 2019/07/19 06:00 MHDA- 2020/03/31 06:00 PMCR- 2019/07/17 CRDT- 2019/07/19 06:00 PHST- 2018/11/08 00:00 [received] PHST- 2019/06/20 00:00 [accepted] PHST- 2019/07/19 06:00 [pubmed] PHST- 2020/03/31 06:00 [medline] PHST- 2019/07/19 06:00 [entrez] PHST- 2019/07/17 00:00 [pmc-release] AID - 10.1007/s10151-019-02023-9 [pii] AID - 2023 [pii] AID - 10.1007/s10151-019-02023-9 [doi] PST - ppublish SO - Tech Coloproctol. 2019 Jul;23(7):639-647. doi: 10.1007/s10151-019-02023-9. Epub 2019 Jul 17.